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SANITATION AND 
DISINFECTION 


A CONCISE TREATISE ON DISEASE PREVEN- 

t ■ 

TION WITH SPECIAL REFERENCE 
TO THE COMMUNICABLE 
DISEASES 


CHARLES H. McCULLY, M. D. 

Author of 


“CHEMISTRY OF EMBALMING” 


■> ■' j 

> ^ > 

PUBLISHED BY HERBERT S. FASSETT 


263 WasKington Boulevard, CKicago 


1906 



COPYRIGHT 1906 

By CHARLES H. McGULLY, M. D. 

LOGANSPORT, IND. 



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DEDICA TION 


To the memory of my father whose 
life was devoted to helping the hurt of 
the world this volume is respectfully 
dedicated. 










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Preface 



N presenting this work the chief pur¬ 
pose has been to amass in concise 
form the essentials of disease pre¬ 
vention as it‘relates to the com¬ 
municable diseases, including the 


fundamental principles and facts on which such 
prophylaxis depends. In its preparation the 
writings of numerous authorities have been con¬ 
sulted, including Green, Holt, Smith, Nuttall, 
Osier, Abbott, Welch, Sternberg, et al., and to 
these gentlemen an acknowledgement is hereby 
made. 

In the consideration of special diseases an 
attempt has been made to record in an easily 
accessible form the many little matters of detail 
so essential and yet so easily forgotten. The 
symptomatology, except in so far as it is diag¬ 
nostic, and the treatment of these affections, have 
been omitted believing this phase of the com¬ 
municable diseases belongs rather to the practice 
of medicine than to sanitation. It is hoped the 
matter may be found a practical working guide to 
all who may be called upon to deal with the prob¬ 
lems considered. 







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-doiq dfit fiJxw fsdb oJ noqu bdlffio ad yern odw fb 



.bdidbienod enridf 


•..1 


1 








CONTENTS. 


PART I. 

General considerations relative to the communi¬ 
cable diseases,. 15-89 

CHAPTER I. 

Theories as to causation of disease—Vital and 
chemJcal forces — Mythology of disease — 

Faith cures defined—Germ theory of disease 15-20 

CHAPTER II. 

Bacteria defined — Synonyms — Basis of present 
knowledge—Where bacteria are found—Ulti¬ 
mate disposal—Their motion—Requirements 
— Methods of growth and development — 

Spores—Classifications, - - - - 21-31 

CHAPTER ill. 

Antiseptics—Decomposition defined—Definition of 
Antiseptics—Cause of putrefaction—Disinfec¬ 
tants defined—Effect of antiseptics on micro¬ 
organisms and tissues — Fractional steriliza¬ 
tion—Degree of antiseptics and how deter¬ 
mined—Application of antiseptics—Require¬ 
ments for various purposes ' - - - - 32-37 

CHAPTER IV. 

Disinfection — Importance of — Ways of accom¬ 
plishing—Fire—Heat—Chemicals, - - 38-42 

CHAPTER V. 

Personal disinfection—Distributing agents of in¬ 
fection — Earlier methods — Clothing, hair, 
beard, etc. — Sanitary gowns — Fumigation 
cabinets—The hands,.43-51 


9 





CHAPTER VI. 




Dissection wounds—Real and imaginary danger— 
Rubber gloves — Relative danger of bodies 
—The operator—Time of greatest danger— 
Nature of infecting agent—Course of so-called 
“blood poison”—Its prevention, - - - 52-57 

CHAPTER VI!. 

Preparation of the body for burial—Embalmer’s 
duties and responsibilities begin when—The 
bed and room—Washing the body—Gases— 

The embalmment — Orifices — Dressing and 
placing in the casket,...58-61 

CHAPTER VIII. 

n 

- f' - • • » ' i 

The disinfection of rooms—The responsibility— 
Methods to be employed — Walls and paper 
—Fumigation with gases—Sulphur—Formal¬ 
dehyde—Preparation of the room—Methods 
of generating,.' - - 62-72 

chapter' IX. 

■ i 

The sanitation of funerals—Over-crowding—De¬ 
lays—Bared heads—Kissing the dead—The 
sermon—Ultimate disposal of body, - - 73-77 

CHAPTER X. ''''' 

r' 

Peculiarities of communicable diseases—Cost of 
epidemics—Methods of disease transmission 
Infection and contagion—Nature of infectious 
agents—Susceptibility—Immunity, apparent 
and real; natural and acquired^—Methods of 
acquiring immunity — Serum inoculations — 
Duration of immunity, - . - - - - 78-89 

PART II. 

A sanitary consideration of special diseases giv¬ 
ing of each. Definition — Brief description — 

Cause — Communicable period — Term of 
Quarantine—Other sanitary precautions, - 90-172 


10 



1 


Fig. 

1 . 

2 . 

3. 

4. 


o. 


6 . 


8 . 

9. 

10 .; 

11 . 

12 . 

13. 

14. 

15. 

16. » 

17. 

18. 
19. 
21 . 
22 . 


23. 


ILLUSTRATIONS. 

' i j 



' \f' li •-ii';'Jj 1 ■ / i'' 

Cocci,. 

Page. 

. -1 ij- • i ’i;i ■ jf;'- • 

Bacilli, - - - ... 

■ 21 

Spirilla,. 

■■ - .• 2 2 

Streptococci, - - - - 

.. . 24 

Staphylocci, -. j,.../,/ pp*. 

•„ 1 24 

Dlplococci, 

■' 25 

Diplococci encapsulated, - 

- 25 

• ■ V ’ / 

Tetracocci, - - - i- 

> :. . 26 

Bacilli showing spores. 

V : T, 28 


Vibrios, . : 29 

Micro-organisms showing flagella,- 30 

Culture tubes, - - 35 

Sanitary suit, - - - , .'r ,/ 43 

“ “ . . . ^ . if; 

“ . 47 

“ .I - - 48 

“ “.50 

“ “.51 


Schering’s Formaldehyde Lamp, - - - 62 

Economist Disinfector,.63 

Trenner Lee Formaldehyde Disinfector, - 63 

Truax, Green & Co.’s Antcclave, - - - 64 


11 





Fig. Page 

24. Lentz Formaldehyde Generator, - - - 63 

25. Francis Formaldehyde Generator, - - - G6 

26. Sternberg Disinfector,.67 

27. Durfee Disinfector,.68 

28. Compressed Air Spray, ^ - G9 

29. Sulphur Candles,.70 

30. Sulphur Torches,.71 

31. Gummed Sealing Strips,.72 

32. Variola,.109 

33. Bacillus of Diphtheria,.120 

34. Bacillus of Typhoid Fever, - - - - 128 

35. Micrococcus Lanceolatus Encapsulatus, - 131 

36. Gonococci, - - - • - - - - 138 

37. Bacillus of Tuberculosis, - - ... 140 

38. Sputum Cup,. -141 

39. Amoeba Coli,.147 

40. Spirillum of Cholera, 150 

41. Diplococcus of Pneumonia, - . - . 162 

42. Bacillus of Tetanus, 16.5 

43. Bacillus of Anthrax,.167 

44. Ray Fungus,.168 

45. Bacillus Mallei,.169 


12 


Part I 



- I 


.T > •' 

- A . V - ■ ^ 

J * . O " 

. *-- r 

* ■ • 

r- ' ~ 

' I i 

General Considerations Relative to 
THE Communicable- Diseases. 

CHAPTER I. ' ^ 

‘1"; uj The Causation of Disease. 

; .■ ■? '{^ } i 

The causation of disease has from an early 
period of the world’s history been the subject of 
much theorization and conjecture. What ap¬ 
peared to be the solution to the problem would 
be given out by some reasoner and for years his 
theory would be accepted as the correct one. 
Man, however, has an investigative turn of mind 
and ever seeks to establish new truths or disprove 
old theories, and naturally as the years have gone 
by solution after solution to the perplexing prob¬ 
lem has been offered until at the present time we 
have almost as many theories as scientists, each 
presenting arguments, each possessing facts, each 
numbering its champions and antagonists and 
each worthy of consideration. 

• Operating on the animal economy are the vital 
force and the chemical force. These forces are 
quite separate and distinct, even antagoniz¬ 
ing each other. The vital force is that power 
which from a single cell builds up the entire or¬ 
ganism, appropriates from nutritious material 
furnished it the portions necessary to secretion, 
excretion and innervation, supplies the waste of 



15 


DISEASE CAISATION. 


tissues and tends to keep the body intact resisting 
all disintegrating influences. By chemical force 
is understood the antithesis of the above; the 
cause of waste of the body, disintegration of 
tissue, change of matter from a higher to a lower 
grade of organization and all the retrograde ten¬ 
dencies of the body from a state of health, 
through disease, death and decomposition. Life 
is a forced state of being caused by an ascending 
of vital over chemical force. Health, the exercise 
of function pleasurably or unconsciously, consists 
in the maintenance of the proper equilibrium be¬ 
tween the two and disease is the result of the 
ascendency of the chemical over the vital force 
in some organ or tissue. 

This vital force is man’s direct inheritance from 
a spiritual creator or origin and has existed from 
all time. The chemical force was not known until 
after’ the curse which was pronounced on our 
progenitor and through him on all mankind. 
With this curse was the advent of disease, death 
and decay, and reasoning from this fact there are 
those who regard sin as the direct cause of all 
disease. These reasoners regard every manifes¬ 
tation of disease or injury as a direct evidence of 
some deviation from the law of God and speak of 
the affliction as being punishment for disobedi¬ 
ence. The position is not wholly without argu¬ 
ment since the laws of God are directly inductive 
to perfect health and long life if religiously ob¬ 
served, and since any departure from many of 
these laws—as for example the law of temperance 
in all things—is directly followed by the manifes¬ 
tation of disease and suffering in such a manner 
that the relation can not but be observed. Closely 
related to this class are those who regard disease 
as the possession of an evil spirit. 


16 


DISEASE CAUSATION. 


The mythology of the ancients furnishes an¬ 
other theory of the causation of disease, some¬ 
what analogous to the above. A box with cun- 
* ning and intricate fastening was conveyed to earth 
by Mercury and left for a time in the care of Pan¬ 
dora—^woman—who priding herself on her skill 
and deftness of fingers impatiently applied herself 
to the task of opening the casket. She was soon 
rewarded, the box opening and releasing myriads 
of small insects which at once began to bite and 
sting mankind until the cure had been released 
from a smaller box confined within the larger. 
The box had been sent to earth as a punishment 
for man’s having accepted the gift of fire from 
Prometheus, who had stolen it from the gods on 
Mt. Ol5mipus. The insects were interpreted by 
the ancients as being disease, cold, hunger, etc., 
and the cure as Hope. Acting on this theory 
worshipers of these gods attributed each depar¬ 
ture from healthy function to anger of the gods 
and by sacrifices to these gods sought to avoid 
disease and to cure when attacked. 

According to the chemist there are some sixty- 
five primary forms of matter or elements and from 
these sixty-five elements all things are com¬ 
pounded. At one time this number was placed 
very much higher but on subsequent analysis 
some substances thought to be elements were 
proven to be compounds. There are many who 
believe numbers of the so-called elements of 
today will yet be decomposed into simpler forms 
of matter and there are some who go even so far 
as to say that all forms of matter will be resolved 
into modifications of force, and that strictly 
speaking we have no matter as the term is under¬ 
stood usually. This furnishes a basis for a class 
whose number is not small who reason that dis- 


DISEASE CAUSATIOIV. 


ease is purely a mental state, an imaginary state 
of being if you please. Their reasoning is that 
an organ or tissue can not be affected by any dis¬ 
ease or‘substance for the simple reason one has 
no organ or tissue to be affected and there is no 
such thing as substance to produce an effect. The 
cure or prevention of all abnormal states with 
the class resolves itself into*a simple belief or 
“faith” that one has nOj affection or organ to be 
affected and that he is quite well and comfortable. 

Another class with a considerable following are 
those who estimate all change of function or 
structure by the measure of excess, defect or per¬ 
version. This rule may be employed either in the 
estimation offcause or the estimation of process. 
For example, in simple' indigestion or dyspepsia 
the affection may have been induced by an ex-^ 
cessive amount of food, a deficient amount or a 
wrong kind — a perverted quality. Again this 
measure may be made to estimate the nature of 
the abnormal conditions in that there may be an 
excessive muscular action of the stomach and in¬ 
testines, a deficient action of the same or a 
reversed peristalsis (perverted action) inducing 
vomiting, etc. This theory may be applied to the 
secretions of the stomach in consideration of this 
same disorder. In the same manner it is applied 
to other disease conditions. ’ • 

We have in the germ theory the latest ideas of 
scientific investigators on the causation of dis¬ 
ease. Tersely put it is that certain disease pro¬ 
cesses are due to the invasion of the system by 
certain micro-organisms or their toxines. These 
micro-organisms, commonly known as bacteria 
or germs, are parasitic and vegetable in character 
and are in no manner related to the animal para¬ 
sites. In other words they are not “bugs” as so 

IS 


DISEASE CAUSATION. 


commonly ^called,; but. minute vegetable growths 
belonging to the class fungi, . 

In 1675 Lieeuwenhoek, ^a linen draper of Am¬ 
sterdam, perfected a lens by means of which he 
could see in a drop of rain water the bodies mow 
recognized as bacteria. /The development of the 
germ theory of disease covers a period from that 
time up to the present, In 1840 Henlcg clearly 
formulated the theory^that*living organisms .were 
the cause of certain diseases, a The similarity of 
process between the infectious diseases and fer¬ 
mentation (the cause ^of which jhad _^been^more 
thoroughly investigated and r shown to , bCf, a 
micro-organism) led to investigation . of these 
diseases-, with) the) view, of finding * similar .causes. 
The similarity was marked. ^ Infection corre- 
sponded to the addition of ferment, incubation 
was analogous to a .period of inactivity. The 
fever, outbreak and course p of ' disease < correr 
sponded yery closely to arrise of .temperature and 
active fermentation; the decline rof-disease .^pro¬ 
cesses to. a gradual (Cessation of fermentative pro^ 
cesses and.the subsequent-immunity to the period 
during whichf the 'addition of more ferment was 
followed byono activity. Dr. Henry Green, has 
arranged these similarities very logically' in par¬ 
allel, columnsr^;, Ho jr n r.T!; ; .to • 

It is still a mooted question just how micro¬ 
organisms operate to induce pathological condi¬ 
tions. A mechanical plugging of the capillaries 
by the presence of bacteria in the blood has been 
suggested as the solution but this hypothesis will 
not bear " investigation,, for in certain affections 
known to be of-bacterial'origin, diphtherial for 
example, the blood seems to be entirely free from 
the presence of these organisms. The most rea¬ 
sonable solution that has yet been offered is that 


DISEASE CAUSATION. 


the disturb of functions is due to the presence of 
certain toxines or poisons produced by the 
micro-organisms. The argument of these various 
hypotheses is too voluminous to permit being 
mentioned, but may be found in almost any stand¬ 
ard work on bacteriology. 

The various tests in-the proof that any spe¬ 
cific disease is due to any definite germ may be 
stated briefly. First the germ must be shown to 
be always present in that disease, though the mere 
presence does not indicate that it causes the 
disease. Second, the germ must be artificially 
cultivated (reared on’some medium outside the 
animal) and a pure culture (one that contains 
no other organism) obtained. Third, this culture 
must be used to inoculate a subject and when so 
used must produce the disease. Fourth, in 
analyzing this new artificially produced disease it 
must be found that this germ has multiplied in 
this new host. Fifth, all of the above steps must 
be repeated to prove the theory. Sixth, the acci¬ 
dental presence of the germ in other diseases or 
in health does not disprove the theory. 

This germ theory is not applicable to all forms 
of disease, but only to the infectious diseases. 
The effect of its proof is immeasurable in the 
revolution of treatment and the means of prophy¬ 
laxis. 



20 


CHAPTER II. 


Bacteria. 

Strictly speaking the term bacteria, or schizo- 
mycetes, includes but one of the three great divis¬ 
ions of thallophytes, parasitic, fungi, or vegetable 
organisms demonstrated to be related to the dis¬ 
eases of the human family, the other two classes 
being the yeasts or blastomycetes and the moulds 
or hyphomycetes. The bacteria are the most 
important of the three since they produce nearly 
all the infectious diseases, putrefaction and sev¬ 
eral of the ferments. In common parlance, how¬ 
ever, the term bacteria has come to be applied to 
all three forms or classes of parasitic furigi, para¬ 
sitic here being employed in its brpader sense in¬ 
cluding hosts of dead organic matter as well as 
living. These organisms are one-celled plants in 
which there is no distinction between leaf and 
stem and are with few exceptions characterized 


• • 


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• • • • • 

Fls’iire 1. 

Cocci. 


// < / 

1 

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Figrure II. 

“a*’ Slender bacilli. 

“I>” Short heavy bacilli. 
Bacilli in chains. 


by an absence of chlorophyl, the green coloring 
matter of plants. These organisms are of micro¬ 
scopic proportions, being from 1-400 to 1-20000 of 


21 


BACTERIA. 


an inch in diameter, but are known to be vegeta¬ 
ble in character and not animal by certain micro¬ 
scopic and chemical differences. The cell con¬ 
tents of bacteria is a mass of protoplasm more or 
less homogeneous. There is a cell membrane 
closely allied to gelatine and which markedly re¬ 
sembles cellulose, a substance composed of car¬ 
bon, oxygen and hydrogen and of the nature of 
starch. This cell membrane which under ordin¬ 
ary conditions the microscope fails to reveal be¬ 
comes ^ visible during sporulation and when 
treated with certain chemical substances is shown 
to be surrounded by a gelatinous layer. The 
membrane is elastic. 

The terms germ, microbe, bacterium and micro¬ 
organism, which are applied interchangeably in 
speaking of these bodies are in a general sense 
synonymous but in ^ their restricted application 
differ somewhat. Webster has defined a germ as 
“that which is to develop an embryo; that from 
which anything springs; a point of growth; ori¬ 
gin.” From this definition it may be readily 



Comma bacilli. 

seen the term applies equally as well to the life- 
giving principle of a grain of wheat or corn, to 
the primary element of animal life or to the start¬ 
ing point of some'public movement, as for in- 


22 


BACTERIA. 


Stance a political revolution, as it does to these 
minute organisms under consideration. Microbe 
is really a contraction from the word micro-bac¬ 
terium which constitutes one class of bacteria 
which in itself is only one of three great classes of 
parasitic fungi. In this sense the microbes or 
micro-bacteria include but a very small percent¬ 
age of these vegetations and are of no practical 
interest to the pathologist since no member of the 
class is in any instance disease producing in man. 
In the restricted sense bacteria or fission fungi 
have already received mention in contradistinc¬ 
tion to the yeasts and moulds. Among other dif¬ 
ferences the bacteria grow by fission (transverse 
divison), the yeasts by gemmation (budding) 
and the moulds by means of an apical cell which 
elongates and divides somewhat after the man¬ 
ner of the bacteria. Vegetable parasite is a term 
which includes many structures not microscopic 
and aside from their parasitic and vegetable char¬ 
acter in no manner allied to the organisms which 
have been demonstrated to bear a relation to the 
diseases of man. Micro-organism includes all of 
the above classes, and is to my mind much the 
best term, but is open to the objection of being 
somewhat indefinite. As stated above though 
these appellations have come to be used inter¬ 
changeably and may in all propriety be regarded 
as synonymous except where the restricted sense 
-is called for by the context. 

Three factors enter into ,the influence tending 
to our present status of knowledge relative to 
bacteria, viz: improved microscope, improved 
methods of culture and improved methods of 
staining. One has but to compare the simple 
imperfect lens with which in 1675 Leeuwenhoek 
discovered the animalcules, with the highly fin- 


23 


BACTERIA. 


ished product of modern times, quite free from 
aberrations of form ^ or color and practically un¬ 
limited in magnifying power, to realize what a 









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Fiftiire IV'. Figure V'. 

Streptococci. Staphylococci. 

potent factor this improvement has been in recog¬ 
nizing and classifying the numerous forms of 
bacteria which today we not only recognize but 
isolate and grow with as much certainty of pure 
cultures as the farmer who is careful to put in 
the soil choice seed of a selected variety, and even 
more certainly since we can remove from the soil 
(culture medium) all other seeds (germs), a 

t _ 

thing the agriculturalist can not perform. The 
earlier work of bacteriologists did not include 
efforts at culture. Later, organisms were grown 
in various media, fluid and semifluid, gradually 
the improved methods of culture reaching the 
plane of solid media on which we stand today. 
The results are obvious. Isolation of growths 
can ^ be made that in the earlier days was quite 
impossible. These increased facilities ^of growth 
and examination resulted in the knowledge that 
these organisms were of differing resistence to 
external influences, and that they differed in this 
respect from the tissues and fluids in which they 
were found and from spore forms. Reasoning 
from these facts soon developed vastly improved 
methods of staining these organisms so that their 


24 


BACTKRIA. 


presence might the more easily be detected. To 
repeat, these three factors have been the means 


« 




s *t % 
tl 


• ^ 


A * 


t0 % f* 
9 * 

« , -s- 

» I? 


» ♦» 


FlRiire VI. 

Diplococci. 


~c- 








s> 


9 


<f) ® 








§ 


ts> 




© 


9 


Ijr. iS> 




<S> 


Figure VII. 

Diplococci encapsulated. 


of the more perfect science of bacteriology«we 
enjoy today. 

With the exception of where life is not at all 
possible bacteria are found on all exposed sur¬ 
faces. This statement includes surfaces both 
directly and indirectly exposed and hence the ali¬ 
mentary tract of man. Indeed the human body 
seems to be fairly alive with them the points most 
freely inhabited being the axilla, under and 
around the nails, between the toes and in the 
mouth. The genitalia are likewise freely infested. 
For reasons which will appear later certain por¬ 
tions of the alimentary canal are freer from bac¬ 
terial life than others, the stomach for instance 
being perhaps the most free and the mouth prob¬ 
ably containing the greatest numbers and variety 
for obvious reasons. The abdomen is one of the 
first parts of the human body to present marked 
putrefactive change owinfr to this presence of bac¬ 
teria in the intestinal canal and the excellent con¬ 
ditions for their growth and multiplication. True 
the abdominal organs of digestion are preceded 
in the changes of decomposition by the mucous 
lining of the larynx and trachea, which is also 
freely exposed to bacterial influence, but the first 


25 


BACTERIA. 


changes of marked character are abdominal. The 
-question, do bacteria exist in the perfectly healthy 
body, may be answered in both the negative and 
affirmative. In the negative, for as a matter of 
fact we have no perfectly healthy bodies ; *in the 
affirmative because bacteria are frequently, found 
in bodies presumed to be perfectly healthy. When 
by any means organisms are introduced into 
healthy bodies they either die from the powers of 
resistence of the body or they may become local¬ 
ized and set up a disease process or be walled up 
somewhat after the manner of foreign bodies that 
are shut offi that they may occasion no harm. 
When they remain in the body in a quiescent 
state they are very properly spoken of as latent 
bacteria. 


V. 


09 

•• 


• • 
• # 


f • 
• • 


” V. 




V. 


• • 




• • 
•« 




Figriire VIII. 

Tetracocci. 


The ultimate disposal of bacteria in the animal 
body is in a variety of ways. In the destruction 
of tissue that frequently follows bacterial inva¬ 
sion, ’these organisms are thrown off in large 
numbers by a process of sloughing, the pus and 
sloughs often containing numerous organisms not 
necessarily connected with suppurative processes. 
The excreta furnish an avenue for escape for 
numerous forms of bacteria the feces being the 
most abundantly laden. In health the urine is 
almost free from these growths but in disease, 


26 


BACTERIA. 


particularly iri^ diseases' of the bladder, some 
forms of kidney affections and in certain other 
disturbances of the genito-urinary tract it is free¬ 
ly infected. Some of the organisms which gain 
access to the system ‘are thrown off as waste 
material having died from various causes. The 
various forces which occasion death in these 
germs are, a lack of proper food, contact with 
germicides, or a sort of autointoxication from 
their function of toxic secretion, throwing .off 
substances directly poisonous to themselves, 
namely, indol, scatol and phenol. The remainder 
are cared for by the phagocytes which constitute 
a very considerable percentage of the leucocytes 
or white blood corpuscles. 

Motion of two or three forms is ascribed 
to micro-organisms. First is a quivering resem¬ 
bling that of a form or mold of jelly. This is 
known as molecular or Brownian movement. In 
addition to this some, forms have a wavy or cork¬ 
screw-like movement while some possess genu¬ 
ine locomotion. This latter motion is due to the 
presence of certain hair-like or filiform processes 
known as flagella. These processes may be given 
off from either or both ends of the organism or 
from any part of its surface and may either be 
one or many. * < 

These plants possess certain requirements for 
their growth and activity. Among these require¬ 
ments may be mentioned moisture, a suitable 
temperature and proper food. All forms of bac¬ 
teria require a certain amount of moisture to 
maintain an active existence, but while most 
bacteria are quite destroyed by depriving them of 
water some withstand this deprivation to a very 
considerable degree and a few remain potent. 


BACTERIA. 


though inactive, after practically all moisture has 
been extracted. To this latter class belong the 
bacilli of tuberculosis and it is with this fact in 
view that the various State Health Boards are 
warring against the spitting on streets and floors 
of public buildings and carriers, knowing the 
tubercular sputum so often expectorated (one 
mouthful sometimes containing as many as four 
billion germs) is too frequently carried in the 
form of dust to the air passages of a new host 
where it lights up the disease processes and after 
furnishing a like means of infection to hundreds 
of others goes on indefinitely' and unresisted 
claiming its thousands of victims annually. Bac- 


■ f: 


o } . \ J 

\S I ^ 

-Ki'V 

^' <i 


Figure IX. 

Bacilli showing spores. 


teria can not maintain an active existence in a 
temperature over 60 degrees C. or under 0. These 
limitations are, however, only reached by a few 
organisms most not reaching these extremes by 
from five to fifteen degrees. Disease producing 
bacteria flourish best in a temperature about 
equal to that of the human body, i. e., 37.5 degrees 
C. (98.6 degrees F). The effect of excessive cold 
and heat — freezing, boiling, steamheat, etc.—is 
best considered in connection with disinfection. 
The food supply of bacteria necessarily contains 
hydrogen, potassium, nitrogen, carbon,' phos¬ 
phorus, magnesium, sulphur and some other con¬ 
stituents, and being achloriferous plants they re- 


BACTERIA. 


quire that their food shall be presented in the 
form of decomposable organic matter either liv¬ 
ing or dead since all achloriferous plants lack the 
power to appropriate inorganic substances. A 
further essential feature of bacterial life and 
activity is the reaction of the media which with 



Flg'ure X. 

Vibrios. 


but few exceptions must be either neutral or 
slightly alkaline. 

Many chemical substances influence germ life; 
some through their acidity or alkalinity, some 
through a corrosive power and some through 
their power to coagulate albumen thereby not 
only destroying the germ but also the germ food. 
Electrical currents also effect the activity of 
these organisms and light exercises a powerful 
influence even as it does, over the higher forms 
of vegetable life. The direct sun rays destroy 
certain forms of bacteria but these points like 
excessive heat and cold are more properly dis¬ 
cussed under the caption, Disinfection. 

Parasitic fungi,multiply by fission, by sporula- 
tion, by gemmation or the division of an apical 
cell. The first form applies more particularly to 
the bacteria—bacteria here being used in the re¬ 
stricted sense. The yeasts muliply by gemma¬ 
tion and the moulds by the apicial cell. All forms 
sporulate but the principal function of sporula- 
tion is preservation of kind rather than reproduc- 


BACTERIA. 


tion though all forms do so multiply. By spore 
is meant an immature form so to speak. Indeed 
there seems to be a close analogy between seeds 
and spores. Both present a greater density than 
the fully developed active plant; both are more 
highly refractive than the plant itself; both grow 
at the expense of the plant; both are less sensitive 
to external influences than the plant; and both 

f 

will reproduce under favorable circumstances the 
organism from which they developed. It was 
formerly taught that want of proper food supply 
or lowered vitality was responsible for sporula- 
tion and indeed many hold to this theory at the 
present. On the other hand high authority states 
that sporulation occurs when bacterial activity is 
at the highest and when, the conditions of growth 
are the most favorable, so that just why one cell 
will produce a new cell and another a spore is 
impossible to say. Spores are of two kinds or 



classes, endospores and arthrospores. ? The first 
are produced within cells; > The latter^are never 
within the cells,.but certain cells pK)ssess certain 
peculiarities that entitle! them to pbe t.classed 
spores. It may be stated as a rule that one spore 
is the entire production of one cell. Oi r. '• i 
On basis of hosts, requirements, form, etc., bac¬ 
teria are divided into many classes. On basis of 


30 


KACTERIA. 


requirements there are the aerobics or those 
which can not thrive save in the presence of 
oxygen, the anaerobics or those which can only 
exist in the absence of oxygen and the facultative 
which can accommodate themselves to either con¬ 
dition. Parasitic bacteria are those which require 
a living host whilst saprophytic require a dead 
host and again we have the facultative which 
flourish in either. There are three classes on 
basis of form, the round or micrococci, the rod 
or bacilli, and the spiral or spirilla. Of the round 
forms or micrococci there are the megacocci or 
large round organisms; the diplococci or those 
found in pairs; the tetracocci found in fours; the 
sarcinae found in eights; the streptococci found 
like strings of beads and the staphylococci found 
in groups like a bunch of grapes. Of the spiral 
forms there are the spirochaeta which are thread¬ 
like organisms in a wavy line; the spirolina, a 
thread-like organism, looped; the vibria, a bent 
rod; and involution forms i‘ e., odd shapes. As 
to products or properties there are among other 
classes chromogenic. or color producing, zymo¬ 
genic or ferment producing, saprogenic or putre¬ 
factive and pathogenic or disease producing. 
The above are but a few of the many classes of 
bacteria that have been introduced into the litera¬ 
ture of the subject, many being used by different 
authors in different senses, so that the nomencla¬ 
ture of bacteriology is not only perplexing to the 
average student but even confusing to the spec¬ 
ialist. ’ i 



31 


CHAPTER III. 


; h LZt '■ I - ' : 

c'i;i ^ O'k j , 

r, ■ Antiseptics. 

There is a marked and almost irresistible ten¬ 
dency for all organized bodies to become reduced 
from the more complex to the more simple states 
until the ultimate in elemental structure is 
reached. All organized bodies, in other words, 
tend toward decomposition or to become what 
is commonly designated rotten. These changes 
have been referred to variously as fermentation, 
rotting, decomposition, spoiling, disintegration, 
putrefaction, sepsis, etc., etc. During the several 
successive changes which intervene between the 
very complex structure in the beginning and the 
simple ultimate derivatives numerous products 
are formed which act in various ways. Some 
are characterized by malodorous properties; 
others cause to become unsightly that which is 
desired to remain fair to look upon; others are 
hazardous to the public health either when 
inhaled or when taken into the alimentary tract 
in the form of fermenting or decomposing food 
or drink. In view of the above offensive prop¬ 
erties of sepsis or putrefaction, it is not strange 
that scientists should have sought out the cause 
of the destructive processes, or that a number of 
agents have been brought out to oppose these 
processes of disintegration. Such agents are 
known as antiseptics — meaning literally opposed 
to or against sepsis. In order to appreciate the 
full significance of the term and its usual applica- 


ANTISEPTICS. 


tion, it is necessary to recall the cause of sepsis 
or putrefaction namely, the micro-organism. 
Briefly stated antiseptics are those agents which 
prevent the growth and activity of bacteria, not 
necessarily destroying them as do the disinfect¬ 
ants which are germicides and which will be con¬ 
sidered later. From the above it will appear that 
disinfectants are essentially antiseptics but that 
an antiseptic need not necessarily be a disinfect¬ 
ant. As a matter of fact, however, most anti¬ 
septics differ from disinfectants only in degree of 
application or of concentration and become disin¬ 
fectants when more thoroughly applied or more 
thoroughly concentrated. 

The effect of antiseptics being to render living 
organisms inoperative, this result must be 
brought about either by destruction of the living 
organism (though this action is only induced by 
a disinfectant) by a perversion of its food supply 
so that the organism is ineffective through de¬ 
ficient nourishment, by a reduction or elevation 
of temperature below or above which they may 
not remain active, or by changing the media in 
which they are found until it is no longer hab¬ 
itable. The food of micro-organisms must be in 
the form of soluble (destructible) compounds 
and that which tends to harden or render less 
destructible those compounds naturally destroys 
bacterial food and is an antiseptic just in the 
degree it possesses the power. Much of the food 
of these organisms being albumen or albuminoids, 
which they render liquid it is obvious that any 
chemical that will harden albumen or albumin¬ 
oids or that tends to render them insoluble acts 
as an antiseptic as has been stated above just in 
the degree it possesses this power and of a very 
large percentage of antiseptics it may be said. 


33 


ANTISEPTICS. 


they coagulate albumen. The extremes of tem¬ 
perature between which these organisms retain 
their power of activity have been mentioned 
above (see page 28) and need not be repeated. 
The process of preserving foods by means of ele¬ 
vated temperatures involves the principles of 
sterilization — destroying germ life present — 
and then excluding the sterilized articles from 
further contamination with germ life. This pro¬ 
cess is sometimes a failure simply from the fact 
the temperature has not been sufficient to destroy 
all bacteria and all spores or the sealing has been 
imperfect. Fractional or intermittant steriliza¬ 
tion overcomes this difficulty. Cold storage pre¬ 
servation depends on the principle that below a 
given temperature bacteria are ineffective. In 
the matter of media any thing that will give to 
the media an acid reaction or more than a slightly 
alkaline reaction to litmus renders, with but few 
exceptions, the organisms in that medium in¬ 
operative and is an antiseptic in that proportion. 
For this reason a sour lemonade is better for 
drinking purposes than a suspected water even 
though the lemonade may be made of the sus¬ 
pected water. Nearly all antiseptics depend on 
one or more of the above principles for their 
power. 

In speaking of antiseptics it is usual to ascribe 
to them a definite degree or power of antisepsis 
which is usually expressed in the form of a ratio 
as, 1:725 or 1:19. The full significance of this ex¬ 
pression may not be perfectly clear to some and 
is best illustrated by a full description of how the 
antiseptic power of any chemical is determined, 
a ratio power being usually applied to chemical 
antiseptics. To a test tube containing a known 
amount of sterile medium a definite amount of 


ANTISEPTICS. 


the chemical to be tested is added and the tube is 
then inoculated with the organism with which 
the tests are to be made. If at the end of a defi¬ 
nite number of hours, usually twenty-four, no 
growth appears, another test is then made with a 
less amount of the cherriical and the process re¬ 
peated until a point is found just below which 
the micro-organisms will increase in numbers 
and remain active. The proportion of the chem- 


a. b. ,, ^ c. 



Figure XII. 


Culture tubes showing rapid growth of bacteria. 

“a” 36 hours, “b” 60 hours, “c” 84 hours. 

ical to the medium at this point represents the 
antiseptic value or power of the chemical. Usual¬ 
ly for sake of comparison a control tube is kept 
along side the tube in which the test is being 
made. This control tube is exactly similar to 
the other in all particulars save that the chemical 














































































ANTISEPTICS. 


is omitted. The amount of medium is the same 
and the germs with which it is inoculated are the 
same. In all cases of course the control tube 
should show growth. Since the power of resist¬ 
ance to chemical! antisepsis differs in the various 
micro-organisms the antiseptic value of a chemi¬ 
cal varies, depending on the germ with which it 
is tested. However, only one, the average power 
is usually given. It is obvious from the above 
there is always a choice ’ of, chemicals in dealing 
with infected substances, which depends on the 
germ or germs present and their tolerance or 
resistance of certain antiseptics or disinfectants. 

The application of antiseptics enjoys' a wide 
range in medicine, (including surgery), and the 
preservation of foods, displays, (pathological, 
horticultural, etc.), and dead bodies. In a general 
consideration of the subject such as this only the 
chief points can be mentioned. The general prac¬ 
titioner finds use for these agents in overcoming 
bacterial activity in the various canals and cavi¬ 
ties of the body, the surgeon in preventing and 
combatting sepsis in wounds and injuries, and 
the sanitarian in preventing the spread of infec¬ 
tious diseases. In other avenues of application 
there are as varied uses each special act of pre¬ 
servation having certain peculiar requirements to 
be met. In the field of internal medicine many 
valuable antiseptics are restricted in use or are 
not at all applicable owing to their toxic proper¬ 
ties. The same precautions of selection must be 
observed in food preservation in addition to a care 
that the palatability of the food be not impaired. 
Poisonous antiseptics are not objectionable in the 
preservation of pathological or horticultural dis¬ 
plays, but one must be employed that will not 
change the color or appearance of the specimen 


3G 


ANTISEPTICS. 


and that will remain unclouded, if the specimen 
be submerged, so that the object preserved will 
not be obscured. Human bodies must be pre¬ 
served with antiseptics that are not offensive 
themselves, that do not give to the corpse an 
unnatural appearance, that will not desiccate and 
that are easily applied. In brief the requirements 
of an embalmer’s antiseptic for body preserva¬ 
tion are ease of application and efficiency of 
action resulting in a lifelike appearance and safety 
to the public. Nothing short of the first require¬ 
ment will satisfy the embalmer; nothing short 
of the second will satisfy the friends and nothing 
short of the last will satisfy health authorities. 
Thus it will be seen there must be a large list of 
antiseptics in which the operator must be skilled 
in selection in order to meet the numerous and 
varied conditions and requirements demanded of 
him in the application of means-of preservation. 
That which will prove ideal under some circum¬ 
stances may be of no avail at another time and 
under other conditions and the-time is now here 
when he who would succeed in these fields must 
be conversant with the various properties, chem¬ 
ical and physical of the agents he employs. For 
a further consideration of special antiseptics and 
the choice to be made under varied circumstances 
the reader is referred to a work on the Chemistry 
of Embalming by the author. 


I I ■ i 

. • I 



37 


..r • 


V 


CHAPTER IV. 

>! 1/'! 

' <“ • *•* t 

\ Disinfection. 

' i • • 


Of the many questions to be considered by the 
sanitarian and embalmer there is no more im¬ 
portant one than disinfection and there is no other 
line on which he should be examined so closely, 
for on his appreciation of its importance and on 
the degree to which he is thoroughly conversant 
with the various methods and their relative value 
in given' cases depend the lives and financial in¬ 
terests of the public. Professional pride and close 
competition for business will force the embalmer 
to employ successful methods of embalming and 
up-to-date funeral etiquette, but a perfectly pre¬ 
served body and a smoothly conducted funeral do 
not necessarily imply a freedom from wholesale 
infection of the public with disease germs that 
•may claim their scores of victims and nothing 
short of a thorough and practical knowledge of 
the necessity of complete disinfection and the 
means of effecting the same, so forcibly presented 
as to fully acquaint the operator with his respon¬ 
sibility in this direction will insure to the public 
any degree of protection whatever. The one who 
is not thus informed may be forced by public 
opinion or the law to employ some means of dis¬ 
infection but he will naturally resort to those 
methods that are the most convenient and easy 
of application regardless of efficiency or special 
adaptation to any given case and when called on 
for certificates of proper disinfection will either 


38 


DISIINFECTION. 


ignorantly or wilfully certify the work has been 
properly performed, when in reality only a form 
of disinfection has been observed and no real 
good has been accomplished. It is easy to under¬ 
stand how such a lack of definite knowledge on 
the part of an individual frequently coming in 
contact with the most destructive and virulent 
micro-organisms may be and unquestionably 
often is the occasion of a widespread infection of 
even an entire community. Antiseptics which 
were treated of in the preceding chapter will ac¬ 
complish all that is desired in the preservation of 
a body in life-like appearance and will obviate 
unpleasant odors, etc., but disinfection alone can 
render a body, a room, persons or things that 
have been in the presence of infection, safe for 
public contact. 

At the present time there are three ways of 
accomplishing a disinfection i. e., the complete 
destruction of the infection or contagion; first 
by fire; second by heat, either dry or moist; 
third by chemicals. In addition to these three 
means of disinfection there are mechanical 
measures by means of which the processes may 
be aided materially. These different means of 
disinfection have each much to recommend and 
each has some objectionable features that can 
not be overlooked. 

In fire we undoubtedly have the most effective 
of all means of disinfection destroying as it does 
all organic structures. It is applicable to all 
forms of disease eerms, but owing to this same 
property of destroying organized matter and 
materially effecting metals and many inorganic 
substances it .can only be employed in a limited 
number of cases. The most practical application 
of fire is where the seat of the infecting agent is 


80 


DISINF-ECTION. 


some utterly worthless article or something that 
can in no other manner be disinfected. That it is 
thoroughly effective is obvious. It may often be 
made practical, too, by thoroughly mixing the 
infected material with some combustible matter 
and then consuming the whole, as mixing feces 
with sawdust or straw and applying fire. Where 
other methods have proven futile entire build¬ 
ings have been razed by this destroying element 
for the sole purpose of removing a source of 
infection. 

Dry heat to be effectual as an agent of disin¬ 
fection must be applied at from 100 degrees C. to 
250 degrees C. and must be prolonged from one- 
half to several hours, depending on the nature of 
the article, its resistance to heat and the organ¬ 
isms to be destroyed for not all are affected by 
heat alike. It is true most bacteria do not main¬ 
tain an active existence above 55 degrees C. or 60 
degrees C., but they are not destroyed by these 
temperatures and when once a lower temperature 
is reached they are again active. In other words 
a temperature of 55 degrees C. or 60 degrees C. 
acts only as an antiseptic, not as a disinfectant. 
To act as a disinfectant dry heat must be pro¬ 
longed as above mentioned until germ and spore 
are destroyed. This prolonged action of dry 
heat is injurious to fabrics and colors, so that the 
'applicability of dry heat for this purpose is quite 
limited. It may be also very properly objected 
that dry heat is not easily controlled and that one 
can not be sure all of the material to be disin¬ 
fected is reached by these high temperatures. 

Moist heat is usually applied in the form of 
steam or boiling water and as such we have a 
much more effective and practical agent, one that 
is of broad application. Moist heat to act as a 

4« 


DISINFECTION. 


disinfectant does not need to reach that high 
degree necessary in the application of dry heat, 
neither need the application be for so long a time. 
Boiling from twenty to forty minutes destroys 
all pathogenic bacteria and is easily applied to all 
articles of clothing, not injuring even delicate 
fabrics. Where steam is applied for disinfection 
purposes it should be under pressure thereby 
rendering it more effective. There are on the 
market numerous forms of steam sterilizers (dis¬ 
infectors) that make this a most desirable and 
convenient manner of securing a disinfection. 
Steam is the agent employed in most hospitals 
for the disinfection of towels, linen, blankets, etc. 

In chemicals we have a long list of disinfect¬ 
ants that are effective or not just as they are 
understood and properly selected and applied. 
In selecting a chemical disinfectant one must 
consider its power over the germ to be destroyed, 
its effect on the articles to be disinfected, its 
probability of reaching all points of infection, the 
quantity necessary to be effected and its cost. A 
chemical that will effectually destroy some bac¬ 
teria may be almost powerless with others so that 
to choose intelligently from the long list of chem¬ 
ical disinfectants one must have a complete 
knowledge of each and its germicidal power over 
the various bacteria. This knowledge must also 
include a thorough understanding of the effects of 
these various agents on fabrics, colors, metals 
and all other substances likely to require disin¬ 
fection, else an agent may be employed that will 
ruin valuable articles as completely as though 
the disinfection had been by means of the sim¬ 
plest method, that of fire. Again it is obvious to 
be effective as a disinfectant a chemical must 
reach all parts of the infectious matter and in 


41 


DISINFECTION. 


sufficient quantities to destroy germ life. Almost 
every one knows that formaldehyde is destruc¬ 
tive to germ life, but no one would suppose a 
drop of forty per cent, solution would effectually 
destroy a barrel of microbes and yet this is 
scarcely more absurd than the sublime faith so 
confidently reposed in some of the old time 
methods of fumigation and disinfection as prac¬ 
ticed by the uninformed. Some of these methods 
as practiced are worse than no effort at disinfec¬ 
tion at all since they inspire a false sense of 
security. 

The subject although practically unlimited is 
worthy one’s closest study and untiring applica¬ 
tion for as stated above, on it depends not only 
property interests but indeed the lives of the 
public. 




42 


1 


t r4 -T 










r CHAPTER V. 

. .;:-L 

■ / :»>:Personal Disinfection. 



Fifeiire XIII. 


The work of the physician, the health officer 
and the embalmer is peculiar in that it calls for 
an entrance into the presence of the most viru¬ 
lent and dangerous contagium and at the same 
time demands that they come out and mingle 


4.3 


PjEUSONAL DISINFECTION. 


with fellows, and that without hazarding the 
lives or health of others. Members of the family 
or other individuals exposed to dangerous dis¬ 
eases may be held in quarantine until all danger 
is past and the clothing, etc., may be disinfected 
by slow processes but not so with the physician, 
the health officer and the embalmer. These must 
at all times enter into the presence of diphtheria, 
smallpox, yellow fever, etc., and on a moment’s 
notice must be ready to leave these places to 
mingle in society or to enter into the homes of 
others not exposed to the disease in question. 
How shall this be done and what precautions 
shall I take to avoid contracting these diseases 
myself or carrying them to others are ques¬ 
tions of paramount importance to every one fol¬ 
lowing these professions. 

Whilst of most and probably all transmissible 
diseases the cause is to be found in the ever pres¬ 
ent micro-organism its actual presence has not 
been demonstrated in all. Be that as it may the 
essential thing to know is how the elements of 
contagion or infection are transmitted and how 
the transmission may be prevented. The various 
forms of contagia are to be found in the air, the 
food, drink, excreta and all that comes in contact 
with the infected. The air, food, drink, bites 
and stings of insects, etc., are however the 
most usual carriers of the offending agents. It 
is obvious from the above the one who comes in 
contact with the transmissible diseases must be 
well guarded in his operations to avoid all possi¬ 
ble sources of danger. 


41 


PERSONAL, DISINFECTION. 


One is most likely to carry* infection away in 
the clothing, beard or hair although it is quite 
possible to distribute it from the hands, the 
mouth,or even shoes and since there is no more 
practical application of the old adage, “An ounce 
of prevention is worth a, pound of cure,” than to 



FIfture XIV. 


the question in hand it is in the province of these 
pages to tell just how one can go in and out from 
the presence of the unclean thing and yet not 
defile himself or his neighbor and to give this in 
a practical form that can be put into practice 
at trifling expense. Formerly when any thing 


45 






PERSONAI^ DISINFECTIOX. 


at all was attempted in this direction the process 
was quite simple. The clothing was changed 
and hanged out to the air and sun for a short 
time to be donned again the next or perhaps the 
same day. The hands and face were washed and 
all thought to be safe. Occasionally some over¬ 
cautious person sacrificed his clothing to the 
disinfection of fire but only after exposure tC) 
such a loathsome disease as smallpox. Later 
antiseptics (mild) were used in washing the 
hands and face and the clothing was lightly 
sponged with a weak solution of carbolic acid or 
in some instances fumigated after a manner with 
sulphur fumes, better than the first but still 
inefficient. The methods now at our command 
are very simple, inexpensive and at the same time 
absolutely safe. 

First as to clothing. Every one whose busi¬ 
ness takes him to the presence of the communi¬ 
cable diseases should have an air-tight cupboard 
or wardrobe and some means of generating 
formaldehyde gas. Into this cupboard he should 
place his clothing and other articles to be disin¬ 
fected and the generator should then discharge 
into the container a volume of formaldehyde gas 
until it shall have reached a concentration of at 
least two per cent. One pint of a forty per cent, 
solution of formaldehyde will, when judiciously 
handled, produce about fifty cubic feet of gas or 
enough to properly disinfect 1,250 cubic feet of 
space. The amount of forty per cent, solution 
and resultant gas can be calculated from this 
base. The articles to be disinfected should be 
left in the presence of this gas for not less than 
twelve hours. When a complete change of cloth¬ 
ing, the cabinet or the generator are not conven¬ 
ient the following makes a very good substitute 


40 


PERSONAL, DISINFECTION. 


method of handling these cases: Let the operator 
be provided with a satchel and a long gown 
(see figures 13, 14, 15, 16, 17, 18) that will 
completely cover from the neck, (better still 
if a hood be attached) to the floor. The one I use 
covers even the shoes and their soles. Before 



FIfturc XV. 


entering the presence of contagion let him don 
this gown and on leaving let him remove it plac¬ 
ing it in the satchel. The next step is to moisten 
a number of balls of absorbent cotton with a 40 
per cent or better a 20 per cent solution of formal¬ 
dehyde, place them around the gown and close 


47 



PERSONAL. DISINFECTION. 


the satchel leaving it closed until required for 
use again. If the shoes have not been covered 
they should be lightly sponged (particularly the 
soles) with the same solution. The beard and 
hair must be cleansed with some good antiseptic 
for which purpose I prefer a weak solution of 



Figure XVI. 

carbolic acid. When the cap or the above men^- 
tioned hood is used the washing of the hair is of 
course unnecessary. Other articles exposed to 
the infection may be treated after the same rules. 

Nurses and others who are in the presence of 
diphtheria are frequently observed to have in 





PKRSONAI. DISINFECTION. 


the mouth, nose and throat numbers of the bacilli 
of diphtheria. If of diphtheria why not of other 
diseases? For this reason the mouth, throat 
and nasal passages should be washed out with a 
mildly antiseptic solution for which purpose the 
alkaline and antiseptic tablets of Seiler or a 
dilute solution of listerine are admirably adapted. 
The operator’s hands, unless protected by rubber 
gloves, are the members necessarily contaminated 
in handling dead bodies. Too, these are most 
likely to be slighted in the process of disinfection. 
The surgeon who enters upon an operation of 
any magnitude whatever is inexcusably negligent 
unless his hands are thoroughly disinfected by 
one of a number of approved methods one of 
which is as follows: First thoroughly wash in 
hot water frequently changed for ten minutes 
using freely a stiff brush and green soap or the 
ordinary soft soap of the kitchen. This is to be 
followed by immersing the hands in a hot sat¬ 
urated solution of permanganate of potassium 
until stained a nut brown. Next the hands are 
immersed in a saturated solution of oxalic acid 
as hot as can conveniently be borne. The appli¬ 
cation of the acid solution should be prolonged 
until all traces of discoloration from the perman¬ 
ganate of potassium have been removed. They 
should then be rinsed in pure sterilized water or 
lime water. The concluding steps of hand 
sterilization should be washing in alcohol or 
ether or both. Curiously enough nail scrapings 
or scrapings of the skin after the above men¬ 
tioned cleansing with soap, water and brush, fre¬ 
quently show the presence of large colonies of 
micro-organisms showing the inefficiency of mere 
soap and water cleansing after contamination 
with disease producing germs. 


PERSONAL DISINFECTION. 


I do not know that the same or some other 
fully as vigorous process should be employed by 
the embalmer and sanitary officer but at the 
same time I am not ready to say that it should 
not. What I do know is that the usual careless 
methods of hand cleansing practiced by em- 
balmers and too frequently by physicians and 
surgeons is quite insufficient and it is much better 
to err on the safe side than the unsafe. In 
cleansing the hands some powerful germicide 
should be employed in sufficient strength and for 
sufficient length of time to insure hands free from 
the presence of death dealing micro-organisms. 



Figure XVII. 


50 






PERSONAL DISINFECTION. 


Protection to one’s own person, aside from the 
rights of the public, demands a more rigid and 
thorough, conscientious adherence to the written 
and unwritten laws of sanitation applying par¬ 
ticularly to the principles of personal disinfection. 



Figure XVIII. 

The author’s one-piece sanitary suit. 



51 




>' li . I 


. '.roTOjrfj 
A'/aj brn> 

Wounds of the Knife, Needle, Etc. 

Closely related to the subject of Personal Dis¬ 
infection just considered is the matter of infec¬ 
tious wounds of the scalpel or needle, or infec¬ 
tions of abrasions of the skin. That this poison¬ 
ous nature belongs to instruments that have 
been used on the dead seems to have been im¬ 
pressed so thoroughly on the public that with 
many there is a holy horror at the suggestion of 
handling a dead body and to their way of think¬ 
ing there is no hope for one so unfortunate as to 
sustain an injury from an instrument that has 
been in contact with a corpse. This idea is not 
at all confined to the laity, however, having a 
very considerable following among the inex¬ 
perienced of physicians and embalmers. A large 
percentage of the students of practical anatomy 
enter on the work in the dissecting room with 
hands either protected with rubber gloves or 
smeared all over with vaseline to the great 
amusement or disgust of older operators. Under 
such circumstances I remember once hearing a 
noted surgeon say with evident disgust, “A cat 
can’t catch mice with gloves.” The force of the 
argument has since appealed to me strongly. 
There is some excuse for the use of rubber gloves 
in the event of a surgeon being forced into an 
autopsy, the gloves being worn, however, to pro¬ 
tect patients on whom he is to operate and not 
for self-protection. I have witnessed a student 



i ' CHAPTER VI. 


52 



DISSECTION WOUNDS. 


after having received a slight injury while dis¬ 
secting, rush pell-mell down four flights of stairs 
to consult an official of the college as to his 
probable chances and what he should do to pre¬ 
vent the much talked of and greatly to be dreaded 
“blood-poison.” I have no desire to ridicule the 
idea of any danger in such cases, for as stated 
above there is an element of danger. However, as 
a matter of fact, not one such wound in' a hun¬ 
dred, I believe one might be safe in saying not 
one in a thousand, occasions any* other disturb¬ 
ance whatever than the fear of what may be. 
Further, the human body is no ^more likely to 
produce these infectious processes during its 
decomposition changes .than is the body of any 
other animal dying under similar conditions. 

Not all human bodies seem to possess this 
power of infection in the same degree. Bodies of 
persons having died from diseases septic in char¬ 
acter, such as typhoid, erysipelas, “blood-poison,” 
etc., are much more likely to occasion the infec¬ 
tion of wounds than others. Too, bodies full of 
fluids seem to be more toxic in character than 
spare ones. For the above reasons probably, 
the laity have come to entertain a dread or horror 
of handling bodies dying from “blood-poison.” 
It is for this sanie reason no doubt they so often 
in such cases needlessly resort to fire for the 
destruction of bedding, etc., that mights easily 
have been disinfected by proper fumigation or 
boiling. These wrong impressions as to the 
probability of infection and the proper means to 
avoid it are responsible for the destruction of 
much valuable property annually. 

The operator is a factor of no little importance 
in. this matter of infection of dissection wounds. 
Not all depends on the body. With some the 


.>3' 


DISSECTION WOUNDS. 


slightest scratch is sufficient to occasion the most 
violent symptoms whilst others seem to possess 
a degree of immunity that is hard to understand. 
Something, much perhaps, depends on the state 
of health of the operator.* A person reduced from 
disease processes, particularly a person with 
deranged stomach or disturbed condition of the 
intestinal tract, should not expose himself to the 
possibility of an absorption of toxic factors even 
by placing the hands in contact with the fluids 
of decomposing bodies for such persons seem 
peculiarly susceptible. Fluids of decomposing 
bodies should here be understood to include the 
discharges from extensive septic wounds, either 
ante-mortem or post-mortem. 

Under the above conditions of health it is not 
essential an abrasion of the skin should exist in 
order that poisons may be taken into the opera¬ 
tor’s system. The author has received almost 
numberless wounds, both slight and extensive, 
while demonstrating on the cadaver and appar¬ 
ently with no more serious results than occasion¬ 
ally the formation of a few drops of pus during 
the process of repair. Even the percentage of 
these wounds showing pus formation is scarcely 
greater than in wounds from general causes. A 
few days of very acute suffering with marked 
constitutional disturbance was once experienced 
from cleansing a very foul gunshot wound. There 
were no skin abrasions through which the poisons 
might enter, but there was an empty and mark¬ 
edly disturbed stomach before handling the case. 
These personal equations of the operator will be 
further considered in a subsequent chapter. 

The infective principle of decomposing bodies 
is most virulent a few days after death and grad¬ 
ually lessens after some days; wounds made 


S4 


DISSECTION WOUNDS. 


during a post-mortem examination before the 
body has cooled (in certain cases) and for a few 
days after death being much more liable to infec¬ 
tion than wounds made while operating on a 
body that has lain for weeks on the dissecting 
table and that is in an advanced state of decom¬ 
position. The peritoneal and pleural fluids and 
sites of suppurative processes are more likely 
to furnish the toxic agent than other parts of the 
body. Personally I should fear the peritoneal 
fluids more than any other part of the body. 
Bodies that have been injected with some efficient 
preservative are comparatively free from elements 
of danger. 

The exact nature of the infecting agent has 
not as yet been fully determined. It is believed 
by some to be a living organism or germ that 
enters the system operating after the manner of 
other pathogenic micro-organisms. Others be¬ 
lieve it to be of a chemical character resembling 
or identical with the ptomaines which are chem¬ 
ical bodies alkaloidal in character. These pto¬ 
maines are about fifteen in number; those that 
are toxic in character, not all being poisonous, 
resembling the vegetable alkaloids somewhat in 
their action. They are the agents which so fre¬ 
quently occasion poisoning from the eating, of 
canned meats, fish, etc. 

Though usually referred to as cases of “blood- 
poison” the cases of poisoned or dissection 
wounds are not always a true example of “blood- 
poison,” but often more nearly resemble a case of 
surgical fever. Particularly is this true of the 
mild cases. The difference, however, need not 
be given here since “blood-poison” is to be dis¬ 
cussed more freely under another caption. 


55 


DISSECTION WOUNDS. 


After an absorption of the infectious matter 
either through wounds of infected instruments or 
direct infection of previously existing wounds of 
the skin, the first manifestations of a disease 
process are a sense of danger or malaise followed 
by a chill, fever and thirst. This is soon followed 
by pain in the arm, the hand being the member 
most usually infected. There is also some pain 
in the chest on the side corresponding to the 
point of infection. The course of the lymphatics 
is shown by red lines. The veins become knotted 
and painful. The glands* of the axilla become 
swelled and inflamed and the skin hot. Respira¬ 
tion and the pulse become accelerated, the appe¬ 
tite is lost, the bowels become loose or flatulent 
and in short the patient passes into what is 
termed a typhoid state — not typhoid fever, but a 
condition in which the symptoms'resemble those 
of a low typhoid state. At the point of infection 
a vesicle appears and is soon changed to a pus¬ 
tule. Serous blebs are -formed along the arm, 
delirium follows and is in turn succeeded by 
death. The above outlines the course of a fatal 
case the entire duration of which may not be 
longer than a week dr ten days. 

The treatment of these cases resolves itself 
into two parts — prophylaxis and cure. The 
operator should always examine the hands for 
abrasions of the skin, such as hang-nails, etc., 
before entering into the work of any operation 
and where these exist they should be carefully 
protected by flexil3le collodium or rubber gloves. 
If in the course of operating a. wound occurs it 
has been the practice to at once cauterize it with 
carbolic acid, apply collodium and proceed with 
the work. The practice is irrational in the ex¬ 
treme. The' thing that should be done is to at 


56 


DISSECTION WOUNDS. 


once favor bleeding by a process of suction, nor 
should there be any waiting to wash hands. If 
too much soiled to apply to the mouth, wipe the 
part well with a handkerchief or anything at 
hand, and see to it there is a free flow of blood 
either by means of pressure or suction with lips. 
However, should the lips be used one should be 
certain no abrasion of the mucous membrane 
exists. Following this and before proceeding 
with the operation it is proper to protect the point 
of injury from further danger of -infection by 
proper bandages or collodium. After the opera¬ 
tion is completed the hands should be thoroughly 
disinfected arid the collodium removed. There is 
no real necessity for the use of carbolic acid at 
all, but where the injury is to an extremely nerv¬ 
ous person it may be well to apply a little after 
the free flow of blood and' before dressings are 
applied, solely for the mental effect. After the 
disease process has started the treatment-should 
be left entirely‘to a competent surgeon. 



57 









:■> i. I ^ 


CHAPTER VII. 

The Body—How Shall it he Prepared? 

Having disposed of the questions of personal 
protection of the operator and how he shall avoid 
carrying infection from his cases to the public, 
the next problem which confronts us is what 
shall be done with the body — in what way must 
it be handled and prepared that the public and 
friends may observe their usual rites with a 
degree of safety that is nothing short of absolute 
certainty? 

Much has been written and more said as to 
just when the embalmer’s or undertaker’s work 
and responsibility should begin, some advocating 
that he should not be called until after the body 
has been washed and laid out, insisting the work 
of the embalmer can be done more effectually 
some hours after death than at once. Others in¬ 
sist the undertaker should have complete control 
of the situation as soon as he can reach the case 
after dissolution. My personal views are with 
the latter since in cases of infectious or con¬ 
tagious diseases much damage may be done 
through a careless or ignorant disposal of bed¬ 
ding, clothing, etc. True if present the physician 
could direct as to the propert course to pursue, 
but as a matter of fact but few of a physician’s 
deaths occur in his presence and when they do 
his attention is frequently required to render 
service to other members of the family. Again, 
I had much rather prevent a germ activity such 


58 


PREPARATION OF BODY. 


as occurs in a putrefactive process than to combat 
it when once started and for that reason if for no 
other advocate an early embalmment. The em- 
balmer then should be called at once when disso¬ 
lution has occurred. 

It is not the purpose to discuss methods of 
embalming, but as stated above to state in just 
what manner a body should be prepared to be 
handled with perfect safety, to give in detail the 
various steps in such a process but to omit all 
discussions as to what vessels should be raised 
and what fluids used. It is for the sanitarian to 
say what must be accomplished and for the em- 
balmer to say what particular methods are most 
practicable, are best suited to the case in hand. 

The undertaker or embalmer should possess a 
knowledge of the cause of death, the nature of 
the disease and an intimate acquaintanceship 
with the nature of the infectious agent. A case 
of typhoid fever differs materially from a case of 
diphtheria and the preparation of the bodies for 
burial in compliance with the laws of sanitation 
differs almost if not quite as much as do the dis¬ 
eases. Measles is a type of another distinct 
class and cancer differs quite as materially. A 
perfect understanding of all these diseases and 
the nature and distribution of the causative 
agent is essential to success. In a limited work 
such as this it is not practical to discuss in 
detail all the varying conditions that must be 
met. Only a general plan or outline of action or 
treatment must suffice leaving the reader to sup¬ 
ply the essentials of detail that will be suggested 
by the peculiarities of the diseases to be handled. 

The first real work of the undertaker consists 
in the removal from the room of the bedding and 
clothing of the deceased, the body having been 


59 


PREPARATION OP BODY. 


placed on a board covered with a cloth or sheet. 
Foliowingo any* other course the operator would 
necessarily, j come in contact with infected ma¬ 
terial in. the work that is to follow. Again in the 
struggles or relaxations frequently attending dis¬ 
solution involuntary discharges from the various 
orifices of the body occur which are frequently 
highly offensive and infectious and which must 
be removed .before anything like a sanitary 
cleansing process can be instituted. In ^the re¬ 
moval of bedding and clothing two points should 
be observed; not to be careless in raising dust 
and to have at hand a vessel containing an anti¬ 
septic solution in which to,immerse the articles 
removed, i The bed itself should be sponged with 
the same solution, and mattresses put aside to be 
disinfected later with the room. In the event the 
bed is of straw the straw should of course be 
burned. , . r -w 

The body should now be/washed thoroughly 
using plenty.of soap and friction!after which it 
should be sponged with a strong antiseptic. The 
washing of .a corpse is usually performed in a 
very perfunctory manner of no service whatever. 
To be of any service,at all from a sanitary point 
of view. the washing must be very thorough. 

The next'proceedure, in the preparation of a 
body for burial should be the removal of gases 
from the cavities using the trocar and canula. 
This step is made necessary from the tendency of 
these gases, through their pressure power, to 
force fluids from the orifices and through this 
same power to interfere with a full, free and com¬ 
plete circulation in. the embalmment to follow. 
These gases are very offensive and often tpxic in 
character and should be passed through some 
strongly antiseptic solution by>means of a rubber 

«o. 


PREPARATION OP BODY. 


tube attached to the canula — given a chemical 
washing. 

The case is now ready for the embalmment 
proper and it is hardly necessary to add this 
should be done most thoroughly, using both 
cavity and arterial work. The contents of cavities 
can not be reached effectually by arterial work 
alone and the converse is true. Concerning 
methods and fluids nothing need be said other 
than fluids and methods of known efficiency 
should always be employed and these selected 
with a special reference to the needs of the case 
in hand. 

Having completed the embalmment all orifices 
of the body should be closed and sealed with cot¬ 
ton and collodium. This step should follow the 
embalmment since by pressure it would interfere 
with a perfect circulation, and in placing the 
cotton it is well to observe some care so as to not 
distort features. In addition to the above certain 
cases require a wrapping in an antiseptic sheet or 
a wrapping of absorbent cotton at least one inch 
thick. 

# 

At this time the corpse may be dressed for 
burial and placed in the casket. Opinions differ 
as to just when the body should be placed in the 
casket but my idea is the earlier the better, pro¬ 
viding always the above mentioned precautions 
have been observed and the operator knows his 
embalmment has been thorough and sufficient. 
The cover need not be placed on at once but once 
closed tightly the casket should not be reopened. 







CHAPTER VIII. ' ^ ^ ^ 

- * • 

Room Disinfection. 

I 

The disinfection of rooms is a mutual responsi¬ 
bility of the doctor, the undertaker and the health 
officer and yet I^presume no phase of the work is 
more neglected. Doubtless each expects the 
work to beTooked after by the other and in this 
lack of personal interest is to be found the real 
fault. The health officer should know what to 
demand and that his demands have been executed 
before ^raising quarantine. The doctor should 
know what is essential that he may lend his sup¬ 
port, moral and professional, to the efforts of the 
other two. The undertaker being in charge should 
be fully acquainted with the requirements, the 
reasons for them and methods of executing the 
demands of the ^authorities. All should recognize 
the necessity of harmonious action that objections 
of the uninformed or* careless may be met and 
overcome. 



Figure XIX. 

Scherins’s Forraaldeliyde 
Lamp. 


62 


Figure XX. 

Sc herlng’s Formaldehyde 
Disinfector. 





Figure XXI. 

Economist Disinfector. 



Trenner Lee 


Figure XXII. 

Formaldehyde Disinfector. 


63 





KOOM DISINFECTION. 


The several health boards have outlined var¬ 
ious methods of room-disinfection any one of 
which may be efficient or not depending on the 
thoroughness with which it is applied. The prac¬ 
tice of spraying a room with a few ounces of 
some proprietary disinfectant or deodorant (and 
too frequently a deodorant is regarded as a dis¬ 
infectant, which it may not be at all) from a 
small atomizer is not a sufficient disinfection and 
is not the interpretation that should be placed on 



Figure XXIII. 

Truax, Green & Co.’s Autoclave. 

the directions of health boards for spray disin¬ 
fection. 

Before a funeral following a death from a non- 
communicable disease all that is necessary 
is a careful and thorough changing of the 
atmosphere of the room and this to be fol¬ 
lowed after the funeral by the usual house clean¬ 
ing methods. Deaths from contagious or infec¬ 
tious diseases imply more thorough means of 























ROOM DISINFECTION. 


protection. In'^some of these infectious diseases 
of which typhoid fever and dysentery are types, 
a funeral may be held in safety after having 
aired the room and swept it with a broom 
moistened in some antiseptic solution; but after 
the funeral the room should be thoroughly 



Figure XXIV. 

I.entz Formaldehyde Generator. 


cleansed after one of the methods to be herein¬ 
after described. In other classes of infectious or 
contagious diseases where the causative factor is 
of a more virulent type, such as is found in the 
acute exanthemata, diphtheria, etc., before the 
public are admitted there should be a disinfection 


65 



U003I DISINFECTION. 



by means of some gas, the means of generating 
which may be found below. In these cases it is 
well to make doubly sure by following with some 
other methods afterward. 

In cases not recognized as distinctly contagious 
or infectious or for mildly contagious or infec¬ 
tious cases a very satisfactory method is a 
thorough cleansing of walls, ceiling and floors 
with soap and water which should be applied 
hot. Necessarily the amount of water which 
could be applied to a plastered wall is limited. 
Carbolic acid, borax, alcohol, bichloride of mer¬ 
cury or lime added to water makes it more 


Fij^ure XXV. 

Francis Formaldehyde Generator. 






i. 







..r- 


faun: 


•'1 r •r 

.'•si o cr olds:.' 


St 

7::g I .o': 

G--d) 

ViXB 

.ifid) .Tovswo 

'll ,bo'10G. 

-s- 




^ rb bovof.f;': 


i<> 


tjl-isb 

Ofl.t 

s-i:/PG'' ;; 

■ii-iilarui 




U l. iJo 'lOli 

ftf main 10 • Vv-r 

ri;= 7'Li:>'x3i»i >iv! 

'n r’ft-. ■ i\nib for, 

:»d i.iir.-,ir: bi?:: di/odir-.’; 
ni^iirroo bltiodc; 9?rii.. io 
s/fhoW-j }o 

mioj 'jff: ,i3^£v/ ruj 

Ig iatn Off-; bar. 

d bin ,da o:od' 
•v fod to 


Figure XXVI. 

Sternberg Disinfector. 




C7 




ROOM DISINFECTION. 

efficient and applicable to a larger field. It must 
be remembered, however, that any disinfectant is 
valueless unless employed in sufficient concentra¬ 
tion and quantities to insure the destruction of 
pathogenic organisms. In order to be effective 
bichloride of mercury should be of a strength 
not less than 1 part in 1,000 parts of water; 
carbolic acid should be 5 per cent.; chloride 
of lime should contain not less than 25 per 
cent, of available chlorine (6 ounces to the gallon 
of water, using the commercial chloride of lime) 
and the cost of any of the above is so small as to 
be inconsiderable. After the use of these agents 
there should be another general cleansing with a 
free use of hot water. 



Figure XXVII. 

Durfee Disinfector, 









ROOM DISINFECTION. 




Wall paper is frequently cleaned by a process 
of rubbing 'with glutinous bread or some similar 
substance, sweeping and scraping. The ^process 
is not applicable to roughened or cracked sur¬ 
faces and is objectionable from the fact that 
particles of the bread will cling to the walls and 

t 

afterwards drop to the floor subsequently scat- 
tering the organisms in the form of dust. In all 
cases the paper should be removed and the walls 
disinfected before repapering. 

Fumigation with some form of gas destructive 
to microbic life has long been used as a disin¬ 
fectant and sulphur fumes the most commonly 
employed. For a number of reasons I do not 
regard the agent as a good one though it will do 


Fissure XXVIII. 

Compressed Air Spraying Outfit. 








69 








ROOM DISINFECTION. 


the work in some degree if .properly handled. It 
affects only exposed surfaces and is injurious to 
many substances. This injury is due to the very 
process which renders it at all effectual as a 
disinfectant, a transformation of the sulphurous 
acid (H 2 SO 3 ) to sulphuric acid (H 2 SO 4 ) 
through an absorption of one atom of oxygen 
from the air. The presence of moisture in the 
air with the fumes renders the agent more effect¬ 
ual. Indeed this presence of moisture is essential 



Figure XXIX. 

Sulphur Candles. 


though in the same manner and degree it renders 
the process more destructive. To be of any value 
whatever at least three pounds of sulphur must 
be burned for each 1,000 cubic feet of space and 
all openings must be securely closed for several 
hours. To secure complete combustion the sul¬ 
phur should be thoroughly moisened with alcohol 
before igniting it and as a precaution against fire 
it should be burned in a vessel surrounded by 
water. 

70 ‘ 


R003I DISINFECTION. 


The best means of room disinfection at our 
command is, in my judgment, formaldehyde gas, 
since it is safe, efficient and not injurious to fab¬ 
rics or metals. To be effective, however, it must 
be introduced into a room to the extent of not 
less than two per cent and the time of exposure 
should be not less than twelve hours. This gas 
may be generated by a variety of ways; either 
sprinkling a diluted solution on the floor, bed¬ 
ding, etc.; sprinkling suspended sheets with a 40 
per cent solution or the same diluted; by heating 
the 40 per cent, solution to 70° F after adding ten 
per cent, calcium chloride to prevent polymeriza¬ 
tion; or by means of specially constructed appli¬ 
ances for the combustion of wood alcohol or 
pastiles of formalin. Where the gas is to be gen- 



FiRure XXX. 

Sulphur Torches. 


erated from wood alcohol no appliance is suffi¬ 
cient that will not consume one quart of the alco¬ 
hol per hour. Where the solutions are used as 
suggested above, each 1000 cubic feet of space 
calls for one pint of the forty per cent, solution of 
commerce. When properly handled one pint of 
the 40 per cent, solution should evolve about 50 
cubic feet of gas. This is stronger than the re¬ 
quired two per cent. Indeed it should be five per 
cent but not all so-called 40 per cent, solutions are 
reliable and it is much better to err on the right 
side than on the wrong. Another effective and 
simple method of disinfection may be mentioned. 
This method is safe and requires no special 


71 


ROOM DISINFECTION. 

apparatus. About thirteen ounces of perman¬ 
ganate of potassium are placed in a three gallon 
vessel in the room to be disinfected, the room 
previously warmed. Over this permanganate of 
potassium is poured two pints of forty per cent, 
formaldehyde, the operator leaving the room at 
once and closing it tightly. The room is kept 
closed for five or six hours at which time the 
disinfection should be complete providing the 
room has been properly prepared by opening 
drawers, etc., and disarranging contents, bedding, 
etc. The above amounts should be used for a 
room of 1,000 cubic feet. True this method re¬ 
quires more formaldehyde than is usually recom¬ 
mended in other methods, but the safety and 
simplicity of the method should compensate for 
the additional amount of chemicals required. 
After disinfection by means of formaldehyde gas 
a room may be quickly cleared of the gas by free 
ventilation and sprinkling floors with aquae 
ammonia. In disinfection of rooms by means of 
any gas all drawers should be opened, clothing 
and bedding spread out and all openings from 
the room tightly closed. 



Figure XXXI. 

Gummed Sealing Strips. 


72 





’ t ' 

'' ^ J . f [ I I 

CHAPTER IX.‘ ^ 

V , ^ 

General Observations on Funerals. 

It might not be out of place in this connection 
to offer a few general observations on funerals 
from a sanitary point of view, including an array 
of sanitary considerations not easily classified 
but none the less important because of this 
difficulty. 

The tendency of latter days to make the dispo¬ 
sition of our dead a display, a place of amusement 
or entertainment for many, a show in plain terms, 
has grown to such proportions that an over¬ 
crowded (even to overflowing)’ house or church 
is no uncommon occurrence. Draughts of air 
from open or constantly 'opening doors are under 
such conditions unavoidable, and coming as they 
do at a time when the vital forces are greatly re¬ 
duced through loss of sleep and grief they can 
not be other than productive of evil results. 
Recently much importance has been given to 
dust as a carrier of disease and numerous ailments 
have been classed under a general caption dust 
diseases. How such assemblages of people might 
act in the carrying of such infection and widely 
disseminating it through agitation by means of 
much walking on carpets and the sweeping of 
long dresses is not difficult to understand and 
needs no elucidation. 

Another source of unnecessary exposure is 
found in the protracted delays sometimes met 
with which may be due to a tardy minister or 
undertaker or an unfinished grave. The case is 


73 


THE SANITARY FUNERAL. 


too plain to need comment and the remedy 
equally plain. Any one who accepts a responsi¬ 
bility in connection with a funeral service should 
let nothing prevent a prompt and faithful dis¬ 
charge of duty. 

Numerous reasons exclaim against the practice 
of waiting at the grave until it is filled, more fre¬ 
quently observed in rural districts. The delay 
often means exposure to storms, wet grass, snow, 
extreme heat or cold. Hats are frequently re¬ 
moved during this part of the rite exposing the 
head to influences that cannot be otherwise than 
detrimental to health. Another feature^ of this 
practice is the nervous haste with which the sex¬ 
ton or pall-bearers close the grave. During the 
cool months this is perhaps not such a factor, 
but every one knows what a tax on one’s energies 
it is to be hurried in the performance of an 
unaccustomed duty whilst friends of the deceased 
wait anxiously for the dismissal when they may 
be alone with their-^grief. i 

• Kissing is regarded by all sanitarians as a dan¬ 
gerous practice, particularly the kissing of a 
sick person or corpse. One needs but a faint 
conception of the germ theory of disease to ap¬ 
preciate how dangerous such a practice might be, 
nor is the micro-organism the only factor to be 
considered. The various fluids of the dead body 
are not infrequently highly toxic aside from the 
presence of bacteria and the fluids used as pre¬ 
servatives are often of a poisonous character. 
These latter are sometimes present on the face 
in dangerous quantities. Kissing the dead is a 
practice that should not be tolerated under any 
circumstance. 

Stories of self torture that come to us from 
heathen nations are shocking in the extreme and 


74 


THE SANITARY FUNERAL. 


it is hard to understand just how such a system 
has become so thoroughly established in some 
quarters of the globe, but as a matter of fact the 
intensifying of grief and suffering occasioned by 
our modern funeral methods, the constant visita¬ 
tions of uninterested meddlers, the public parades 
around a casket whilst gratifying curiosity under 
the garb of paying respect to the deceased and 
bereaved, and too often the remarks of the min¬ 
ister tend to increase rather than diminish the 
suffering of friends and in so doing lessen the 
disease resisting powers that are already over¬ 
taxed. The farewell of a family will tax their 
strength and powers of endurance less if taken iii 
private. Under such circumstances the truly 
grieved and refined will feel less called on to con¬ 
trol honest expression of grief owing to absence 
of vulgar intruders and the hysterical will feel 
less called on for violent demonstrations of a 
more evanescent sorrow. In either circum- 
Stance there is a conservation of energy much 
needed. Then what shall be the remedy to over¬ 
come this unnecessary waste of energy? Let 
the body lay in state sufficient time to permit all 
interested to call and view the remains. At a 
specified hour let the doors be closed, the rela¬ 
tives in private take their farewell and the min¬ 
ister in a few well chosen words offer what con- 

I 

solation he may, not dwelling on points that must 
call out renev/ed outbursts of grief. Then let 
the undertaker remove the body for final disposi¬ 
tion, accompanied only by the immediate friends 
and relatives if by any one. 

What shall be done with the body? Shall we 
bury or shall we cremate? Sanitarians nearly 
all with one accord say cremate but the public 
are not yet ready to give up time honored customs 


THE SANITARY FUNERAL.. 


on demand of science unless science shall give 
good and sufficient reason for demands. If the 
body has been prepared in accordance with the 
rules given on preceding pages it may perhaps be 
buried in perfect safety. The one great objection 
to a burial in the ground is a contamination of 
water with disease agents or poisonous preserva¬ 
tives. The latter is scarcely a consideration. 
The distance to which disease producing agents 
will travel and the obstacles through which they 
will pass is almost incredible, cases being on 
record where they have even passed through the 
base of a mountain and that not by means of an 
open direct current. To meet this element of 
danger in burial some have advocated the liberal 
use of quick-lime around the body by which it 
would be destroyed but the method will probably 
never become a popular one. The antiseptic 
absorbent sheet has recently been offered as a 
substitute for embalming or cremation as a 
health measure. The absorbent sheet is a valua¬ 
ble means of disease prevention as has been sug¬ 
gested on preceding pages but to attempt to 
make it serve in the capacity of substitute for 
embalmment or cremation is absurd in the ex¬ 
treme. The merest novice in principles of sanita¬ 
tion under the present theories of germ origin of 
disease must readily understand it could not be 
made to hold indefinitely or even for any con¬ 
siderable length of time. Neither could it be 
charged with sufficient antiseptic power to disin¬ 
fect the entire organism and if it could the first 
fluids of the body passing through would wash 
away so much of the antiseptic agent the latter 
fluids would pass through unchanged. 

That cremation is effective as a sanitary meas¬ 
ure all will admit, but two points being urged 


70 


THE SANITARY FUNERAL. 


against it. It is alleged that in some cases it 
obliterates evidence of crime and that it is revolt¬ 
ing to the finer senses. The first I am ready to 
admit but will any one insist it is not better to let 
one criminal go unpunished than through fear of 
this to permit a’hundred innocent sufferers to die 
from disease induced through use of a water sup¬ 
ply that has been contaminated from an im¬ 
properly prepared body that has been buried? 
As to cremation being revolting to the finer 
senses, the -consuming of a body by means of 
heat is certainly not more revolting than the idea 
of loved ones being eaten by worms or slowly 
disintegrating through the process of putrefac¬ 
tion, the once pink-tinted flesh hanging in black¬ 
ened putrid shreds to a skeleton that has outlived 
its purpose* Cremation is certainly the sanitary 
way in which >to,dispose of the dead, is growing 
in favor and must soon unquestionably come into 
general use.- 


•j .1^' 



77 


/ ^ 


CHAPTER X. ’ ' ' ^ ^ 

■ . V ‘ t:,'; . .. 

' jv u: _ -•■•[' 

Peculiarities of ^ Communicable Diseases 
Including Susceptibility and Imrnunity. ^ 

ii‘ 'iCD qi. /;j 

A comparatively large per^ cent, of all the 
diseases which afflict the human race may be 
classified as communicable and therefore pre¬ 
ventable. The full force of this argument does 
not come upon us at once but is all too apparent 
when one stops to consider in dollars and cents 
the'cost of a small epidemic to a small community 
and then increases this cost to the many, many 
times necessary to show the cost to an entire 
county or state. A single case of typhoid fever, 
in which the sanitary instructions of the physician 
were not properly observed, resulted in > the 
spread of the disease to the number of thirty or 
more cases, ten at least of which proved fatal. 
On a low estimate these cases would average 
sixty-five dollars for doctor bills. The ten 
funeral outfits would cost on an average of fifty 
dollars each. Estimate the time of the patient 
and two nurses for each patient at one and one- 
quarter dollars per day each for thirty days — 
that being a fair average term of sickness; add 
to this an estimate of five dollars per case, travel¬ 
ing expenses of friends visiting .and board for 
three extra persons each meal for three weeks in 
each case, at three dollars per week; include an 
expense of ten dollars per case for drugs and 
incidentals; estimate each life at five thousand 
dollars; place a thirty-five dollar monument at 
each grave and tabulate the whole as follows: 


78 



COST OF EPIDEMICS. 


Doctor bills, 30 cases, @ $65 each.$ 1,950 

Ten funeral outfits @ $50 each.. ^ \ 500 

Time of patient and two nurses. .. 4,050 

Board, three extra people each case three 

weeks, @ $3 per week. 810 

Traveling expenses @ $5 per case. 150 

Drugs, etc., @ $10 per case. . 300 

Ten lives @ $5,000 each,;... 50,000 

Ten monuments @ $35 each.. 350 

Total. .. :.... .7.$58,110 

V \ 

Think of it, $58,110.00 unnecessary expense in 
three townships from carelessness in handling 
one case of typhoid fever. More than fifty-eight 
thousand dollars were wasted, worse than wasted 
in a few weeks. Think of what this must mean to 
an entire state or country. The Health Board of 
one state, perhaps not more afflicted than the 
average, has estimated the annual cost of typhoid 
to the state at over $5,000,000. One can scarcely 
comprehend the sum and yet it is being worse 
than wasted. Five millions of dollars for the 
privilege of entertaining * so filthy a guest as 
typhoid fever for one year seems almost incredi¬ 
ble. What a woeful waste when less than half 
the amount properly expended would practically 
stamp out the disease of filth and what would the 
balance not do if converted into legitimate 
channels? 

Then stop just long enough to consider that 
typhoid is but one of the many preventable dis¬ 
eases making inroads on our numbers and means; 
that the above computations have not taken into 
consideration smallpox, diphtheria, cholera, etc., 
and the cost of quarantine measures to say noth¬ 
ing of the loss to business such measures neces¬ 
sarily involve. Dr. J. N. Hurty, of Indianapolis, 
Secretary of the Indiana State Board of Health, 


79 















DISEASE TRANSMISSION. 


is authority for the statement in Indiana alone 
are |oo ,000 people who must die of tuberculosis 
in some form, and so the statistics might be piled 
up until we should become lost in amazement 
and forced to exclaim “How long, Q Lord! hoyv 
long” will the people remain in ignorance of their 
own danger and continue to exclaim against 
those who seek to do them good in stamping out 
these scourges? 

Communicable diseases are peculiar in that 
they may be transmitted from one person to 
another. There are four ways in which this 
transmission may be effected. First, the con- 
tagium, by which is meant the causative factor of 
the disease process, may be introduced by a 
direct inoculation, as is the case in vaccination 
and when a disease can be so introduced it may 
be referred to as inoculable. Many of the com¬ 
municable diseases may be so classed. Second, 
the contagium may be directly conveyed to those 
in personal contact with the sufferer or through 
the air of the imrfiediate vicinity such cases being 
referred to as contagious. The danger of con¬ 
tracting a contagious disease increases of course 
with the closeness of personal contact and de¬ 
creases as one recedes from the infected. Third, 
the contagium may be taken into the system by 
way of the alimentary tract, to which it is 
conveyed in infected water or food. Fourth, 
there may be an indirect transmission by means 
of clothing, bedding, hair, beard, instruments, 
etc. Such transmission may be for almost in¬ 
credible distances and be the occasion of wide¬ 
spread infection. The third and fourth classes 
above mentioned are usually spoken of as infec¬ 
tious. In such a classification as just given it 
does not necessarily follow that a disease which 


80 


CONTAGION—INFECTION. 


is placed in one class may not fit equally as well 
in another class. Many of the communicable 
diseases are not only infectious but contag^ious 
and inoculable as well. 

From the above it will be seen there is some 
little difference between the contagious and in¬ 
fectious diseases though these terms are fre¬ 
quently used interchangeably. In the contrac¬ 
tion of a disease by contagion it is necessary to 
come in personal relation with — not necessarily 
touching but in the presence of — the one suffer¬ 
ing from the disease in question. This personal 
contact is not necessary to contract a disease by 
infection, but the contagium may be conveyed by 
means of food, drink, clothing, etc. This distinc¬ 
tion though not infrequently confused is'of some 
considerable importance when it comes to a ques¬ 
tion of quarantine restrictions, since an ailment 
may be infectious and not contagious. ' 

In many of the communicable diseases the 
exact nature of the contagium or infectious agent 
or causative factor as it is variously styled, is un¬ 
known. In others it has been clearly proven to 
be the ever present micro-organism or vegetable 
parasite commonly called germ or microbe. Just 
how these organisms operate to induce disease 
processes and why we know they do so need not 
be discussed here since the matter has received 
some consideration in earlier pages. Neither is 
it deemed advisable to theorize as to the probable 
cause, or its exact nature, of those communicable 
diseases not due to microbic origin since along 
the entire line of thought we are practically at 
sea. 

Individuals and races differ in their suscepti¬ 
bility to the various communicable diseases from 
almost absolute immunity to a readiness to 


81 


SUSCEPTIBII^ITY. ' 

“take” anything on slightest exposure. As an 
illustration some have escaped seizure after 
close personal contact with certain contagious 
diseases even sleeping in the same bed with 
sufferers whilst others as stated have succumbed 
to very slight exposure. Yellow fever vand scar- 
letina are less common among the Negroes than 
among others whilst this race is more susceptible 
to smallpox and tuberculosis. The Hebrews are 
relatively immune to tubercular affections whilst 
the Irish and North American Indians suffer 
greatly. This racial difference of susceptibility, 
however, is probably due more to conditions of 
living than to any inherent differences of organ¬ 
ism. The seeming immunity of the Hebrews from 
tuberculosis may be easily accounted for by rigid 
inspection of meats according to old Mosaic law, 
since doubtless many cases of tuberculosis are 
contracted from the use of infected domestic 
animals among which tuberculosis is common. 
Cutting off this source of infection and taking 
into consideration that Hebrews but seldom 
intermarry with the Gentiles who have not this 
protection and one need not search further for 
a reason for this relative immunity. Dr. Theo¬ 
dore B. Sachs of Chicago, however, presents an 
article in the Journal of the American Medical 
Association (Vol. XLIII, page 390) which would 
lead one to conclude the so-called immunity of the 
Hebrew from tubercular affections is largely over 
estimated. 

Susceptibility depends somewhat on the relative 
state of the individual’s vital and chemical forces. 
To state it differently, general or local depression 
is an important factor. One whose vital forces 
are greatly reduced is obviously more susceptible 
to an infection and disease process than the same 


82 


IMMUNITY. 


individual might be in-.a more perfect state of 
health. To put it more specifically one suffering 
from debilitated conditions of the mucous lining 
of the respiratory passages would be much more 
liable to' an infection from diphtheritic, or tuber¬ 
cular organisms than the same individual with 
healthy air passages even though, in the latter 
instance the exposure may' have' been for a 
greater length of time and in the presence of more 
virulent contagium. These varying conditions 
and general or local depression doubtless account 
for many of those numerous cases of individuals 
who have frequently been exposed to diseases 
with impunity and have subsequently contracted 
the affection from apparently very slight exposure. 

- t 

Immunity from disease which has been men¬ 
tioned a number of times may be defined as that 
state or condition of the system in which one will 
not contract an affection on exposure to its con¬ 
tagium. In a sense immunity is the antithesis of 
susceptibility and hence may depend in some 
degree at least on opposite conditions to those 
which favor susceptibility. The state of immunity 
may be either an apparent, a native or an acquired 
condition. Apparent immunity is not so much 
a state of the system rendering infection impos¬ 
sible as a combination of circumstances rendering 
infection improbable. It may depend on different 
circumstances. This apparent immunity in 
affections of bacterial origin, may result from a 
failure of the infective organisms to reach a tissue 
in which they can act or from a failure of the 
organisms to become arrested or again it may be 
the result of a particularly healthy body with in¬ 
creased powers of resistance or a superabundance 
of vital force. 


83 


IM3IIJJVITY. 


Certain disease producing bacteria act only as 
such when they reach certain forms of tissue. 
Malignant oedema bacilli for example only pro¬ 
duce the affection when lodged in connective 
tissue and when introduced into the blood current 
are not only powerless to produce the disease 
unless they find exit into the tissues but act as a 
factor in producing an acquired immunity against 
the affection. Many of the, pathogenic organisms 
act only when arrested at some point and all are 
more potent in a state of rest. An apparent 
immunity -may also result from the contagium 
being introduced into the system in insufficient 
amounts to overcome the resisting forces. On 
first thought it would seem considering the rap¬ 
idity with which disease producing germs multi- 
ply, that the amount could scarcely be too small 
to induce the disease process, but such is not the 

r t 

case since the various fluids bf the body including 
the blood are in some degree antiseptics or disin¬ 
fectants and as indicated above the resisting 
powers of the system are often sufficient to throw 
off the offending agents. This is particularly 
true where the contagium is in small numbers or 
is in an attenuated form or where for any reason 
whatever the virulency has been lessened and 
hence again an apparent immunity. Persons with 
an apparent immunity who have been exposed to 
infection with impunity may at some subsequent 
period, ‘as stated aboye, suffer an attack from a 
much less exposure owing to the absence of 
some one or more of the conditions which before 
conferred the immunity. 

Natural or native immunity is an inherent state 
of being which renders one exempt from the dis- 
ease process in question. Certain racial peculiari¬ 
ties as suggested above, for instance the relative 


84 


IMMUJVITV. 


immunity of the Negro from yellow fever and oc¬ 
casional instances in which whole families seem to 
possess an immunity against certain diseases are 
very properly referred to as natural immunity. ^ A 
very good example of natural immunity^is also to 
be found in the lower animals, the horse being 
practically .free from tuberculosis ^ which • is fre¬ 
quently found in the ox and swine. Too, natural 
immunity is sometimes most peculiar in its mani¬ 
festations for which we are ^entirely unable to 
assign a good reason.For instance • anthrax 
readily attacks mice but is impotent with rats. 
As intimated above just why^ these facts are true 
we do not know, but that they are true, we know 
and accept them as such. , , r- 

f Acquired immunity -may be defined as an 
exemption from a certain disease process due to 
some systematic change within the individual 
and may result from one of three processes: 
First, recovery from an attack of the disease.Jn 
question; second, from an induced attack of^an 
allied disease processthird, from inoculation. A 
first attack of many of the communicable diseases 
renders the individual free‘fromr any danger, of 
subsequent attacks regardless of exposure.; .In¬ 
stances are almost too well- known >to require 
mention. However, typhoid fever, measles — in 
short all the acute exanthemata belong to this 
class though there are exceptions to the rule with 
nearly all of them.; A few of the communicable 
diseases, erysipelas for example, seem to reverse 
this order and tend to render the individual more 
susceptible with each attack, j,. . - 

The second form of acquiring immunity, by 
means of inducing an attack of'an allied disease 
process which is immunizing, is best exemplified 
in vaccinia or the process ^ which results from 


85 


IMMUNITY. 


introducing vaccine virus into the system and 
which renders an immunity against smallpox. 

Immunity may be acquired as a result of 
inoculation in three different ways, i. e.: inocula¬ 
tion with attenuated virus of the disease; or 
inoculation with chemical products of the organ¬ 
isms of the disease; or inoculation with serum 
from an animal which has been immunized by 
one of the above two methods. Smallpox is 
again the best example of the first method of 
immunizing by inoculation. For many years in 

f 

different countries it has been the custom to 
seek immunity from small-pox by artificially 
inducing a mild attack of the disease by inocula¬ 
tion. These artificially induced attacks are 
usually of a mild type but occasionally assume a 
most severe form. The virus in an attenuated 
form is secured by one of two methods — either 
repeated inoculation through animals but slightly 
susceptible thereby reducing potency or by ex¬ 
posure of cultures to environment that reduces 
their power. One very serious objection urged 
against this method of acquiring immunity 
through inoculation is that while it induces im¬ 
munity from subsequent attacks it sometimes 
induces a severe instead of a mild type of the 
disease, as suggested above, thereby defeating 
the very purpose for which it was intended. For 
this reason other methods have been sought. 

In the second manner of inducing immunity 

through inoculation^ the germs are killed by 

means of certain germicides, frequently oil of 

mustard, and the chemical product of these 

organisms is used. The process is far from ideal, 

not always reliable and not applicable to all of 

• • 

the communicable diseases due to parasitic fungi 
since some of them do not respond. 


86 


IMMUNITY. 


Serum inoculation from animals that have 
been treated by one of the above methods more 
nearly meets our ideal of immunity by means of 
inoculation and is the method most commonly 
employed. This is the process most generally 
known and the one used in the treatment as well 
as the prevention of diphtheria. In the prepara¬ 
tion of this serum (antitoxine as it is usually 
called but more properly diphtheria antitoxine 
or anti-diphtheritic serum) a healthy young horse 
is selected and is inoculated with a small dose of 
diphtheritic toxines. These toxines are not to be 
confused with the bacilli of diphtheria but are 
chemical products of these organisms — see the 
paragraph immediately preceding this one. When 
the fever of reaction following this inoculation 
has subsided a larger dose is administered, the 
process being repeated in increasing doses until 
the animal is no longer affected by the toxines 
(not antitoxines) regardless of the size of the 
dose employed. In other words the animal has 
been rendered immune to diphtheria through a 
process of poisoning with the poisons generated 
by the germs of diphtheria. Just how this im¬ 
munity is conferred is not known, but the fact is 
known. The animal is then bled, the blood being 
collected under aseptic precautions and the serum 
after being separated and combined with a pre¬ 
servative is'put up for use in sealed packages. In 
some unaccountable manner this serum renders 
the subject into whose system it is injected, im¬ 
mune for a time from attacks of diphtheria. 
Incidentally it may be remarked, too, that this 
serum or antitoxine furnishes our best means of 
treatment of this same disease antagonizing as 
the name implies the poisons of diphtheria. Just 
what the agent is which accomplishes so much is 


87 


IMMUNITY. 


not known nor even thoroughly understood. 
There are numerous serums from as many differ¬ 
ent disease producing organisms but antidiph- 
theritic serum is the type as well as the most 
commonly employed. 

The duration of immunity is of course varied 
and indefinite. Obviously an apparent immunity 
may cease at any time and racial immunity is as 
a rule only relative not absolute. Neither is there 
any definite time at which acquired immunity 
may be said to cease. Whilst in most instances in 
which immunity has resulted from an attack of 
an affection, either as the result of accidental 
exposure or artificially induced as a prophylactic 
measure, the exemption is unlimited, there are 
enough exceptional cases to the rule to make 
unlimited immunity a matter to be questioned in 
each individual' case. The immunity from small¬ 
pox afforded by vaccination varies from a few 
years to a lifetime. In order to be sure therefore 
of an immunity through vaccination one should 
be vaccinated in early childhood, again at the age 
of puberty, again at the age of majority and as 
often thereafter as one is exposed to the con- 
tagium or the prevalence of an epidemic. In 
other words to be effective not only vaccination 
but revaccination should be practiced. The dura¬ 
tion of immunity rendered by the various serums 
as for example antidiphtheritic serum is measured 
by weeks or months and must be repeated as 
often if renewed exposure occurs. 

The theories regarding immunity from the why 
point of view are almost numberless. No one of 
the various ideas advanced seemed to hold good 
in all cases and since it is known the communica¬ 
ble diseases result from etiological factors widely 
differing in their individual characteristics may 


88 


I3I3IIINITY. 


♦ 


it not be possible and is it not probable the spe¬ 
cific reasons of an exemption from certain disease 
processes may be as varied as the disease pro¬ 
cesses themselves or their causative agents? Being 
so varied and so little understood it is not advis- 
able to enter into a discussion of these perplexing 
problems. From the above may readily be seen 
that which to the sanitarian is one of the most 
important facts relative to the communicable dis¬ 
eases, namely, the communicable diseases are 
prone to occur in epidemics, the poison being 
increased many fold in each individual case. 

These diseases are likewise peculiar in having 
a definite course to run including a period of ex¬ 
posure, a period of incubation, a period of onset, 
a period of increased activity, a period of declin¬ 
ing activity and usually a period of immunity 
following. There is much variation of these 
periods in duration as well as other characteris¬ 
tics, in the various transmissible diseases each of 
which has a train of symptoms peculiar to itself 
and each of which usually adheres very definitely 
to certain laws of process common to all. So 
perfectly does this rule seem applicable that hav¬ 
ing been exposed and not immune one may with 
a reasonable degree of accuracy and certainty 
that approaches nearly to the absolute, predict 
just what will occur in a given case. Such are 
the peculiar general considerations of the com¬ 
municable diseases, the prevention of which is 
one of the most important duties incumbent upon 
those to whom it is given to be guardians of the 
public health. 


80 


.Y'FTy iff jfV I 


dldfidoiq e't bns »rdi?aoq scf jo/t ti 

'3«fi9Eib’fii£iid::> md*ii noi>qm;jxb a& ^6 anrdE5>^/:)jrJi3 
-oiq 3ffe)5»2ib srffi>6 bshisv-ysm f»9<i39'>diq 
^nbS SE)h^;gi5 svijfieojjD 'tisfl>ho advbeimrfl a^fi6o 
-eivbfi ion ei ti booiEii^bnu sfitil oe brts bshBv 02 

♦ f' 

^^rrijTjlqi^ 925rii lo ncfgan^Eib b x>i Mb 

fia^R !>d '{iibBoi 9vt)ds Mo’^ I .prn^fddiq 

J6om *}dr fo »no eb nBhfdifiBR f»rfj o? ribiffw ijard^ 
-8ib ^IdB^indm/noo ad? OJ a\>^i/Bta7 eiofij jnBtioqrhi 
a7B f!3!i£9etb ^IdBOfirnrritTjdo strfs .^iam£n "".g'^asa 
^niad ftoaioq sffi ,aaf?m^bjqa nx inaoo ot anotq 
' .aejsty iBtjbmbnf rfafia ni Moi ynum baafBaYani 


gnxvEri ni iGifnaaq a«iwadil aie gaasaaib sasdT 
'Xa io'boitaq B ;§/tfbLd:>rff nn*; 0 / »a7];i6!J''aifnd«h s 
,hario !o bohaq g >iioiiBdiioni do bohaq 6 .aiwffdq 
-ttdi?ab }b b'ohaq b ,yiivdioB ba«BdiaiRtf do bdhaq s 
yJmcjmrriT ^lo‘ boiiaq n ylfiKiJEn bnB yimioB '^gni 
d«ari? lo rtbr*fj’nBv [hum d aiadT .^niwollod 
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Special Considerations Relative to 
THE Communicable Diseases. 


Special Diseases. 

In the previous chapters the discussions have 
been of a general character. In the pages which 
are to follow there remain .to be considered 
certain special and peculiar features pertaining 
to each of the communicable diseases which are 
of considerable importance to all those who have 
to deal with these sources of danger. It does 
not suffice that those to whom is entrusted the 
public health to any extent, as for example the 
physician, the nurse, the embalmer and the min¬ 
ister, should know that certain disease processes 
are communicable and may be transmitted from 
one person to another but they should also under¬ 
stand under whal; conditions these affections may 
be transmitted. It is not enough that they should 
understand the necessity for quarantine measures 
but they should know when it is safe to remove 
these quarantine restrictions. An appreciation of 
the necessity of disinfection will avail but little 
without a knowledge of the best, or at least an 
efficient method in any given case and since in 
these particulars the communicable diseases differ 
widely a separate consideration of each is essen¬ 
tial. The consideration of these peculiarities 
would logically follow at this point and will con¬ 
stitute the concluding pages. 




Scarletina, Scarlet FeOer. 


SCARLETINA, SCARLET FEVER, OR 
SCARLET RASH is an acute infectious disease 
characterized by a peculiar rose-colored eruption, 
markedly sore-throat and a high fever. The 
disease usually attacks children under ten years 
of age though adults have been known to suffer 
from it. An attempt to ascribe to the disease a 
variety of forms, designating these so-called 
forms by the names heading the paragraph, has 
resulted in much confusion. 'As a matter of fact 
scarlet fever, scarlet rash and scarletina are syn¬ 
onymous — one and the same thing — and any 
attempt to refer to one case as scarlet rash or 
another as scarlet fever because of any mildness 
or severity of the symptoms is unfortunate and 
not to be encouraged since the milder cases of 
the disease may occasion the most violent and 
should be subjected to the same rigid sanitary 
restrictions. To repeat, the sanitarian should not 
forget and the public should be reminded on all 
occasions that scarlet rash, scarlet fever and scar¬ 
letina are one and the same disease. 

The specific cause of scarletina is unknown but 
from the close similarity in its clinical behavior to 
those diseases known to be of bacterial origin it is 
safe to assume that sooner or later some such 
microbic factor will be found and demonstrated. 

t J X ^ • 

Whatever the infective principle may be, it seems 
to be received and taken into the system through 
the organs of respiration and is conveyed by 
means of personal contact, clothing, hair, paper, 
dishes, rags or discharges from the ears, nose, 
throat, skin, kidneys and bowels. Pet cats, birds 

»4 



SCARLETINA. 


and dogs have also been known to spread the in¬ 
fection. Imperfect ventilation, filth and unclean¬ 
liness seem to increase the probability of infection 
and difficulty of recovery. 

The period of incubation in scarletifia i. e., the 
period from exposure to the first manifestation of 
symptoms is variously estimated at from one to 
seven days, some even extending the period be¬ 
yond this time. Most authors seem to agree, 
however, on the following limitations — least, 
less than twenty-four hours; average one to three 
days; longest seven days. Usually on the second 
day but sometimes within the first twenty-four 
hours of the disease the eruption appears. It is 
first seen on the neck and later on the chest and 

I 

extremities. The eruption appears in the form of 
slightly elevated, scattered red points on a deeply 
flushed skin. Occasionally are seen a few vesicles. 
The eruption generally lasts one or two days, 
sometimes longer, and then begins to fade. Fol¬ 
lowing the eruption is a desquamation or peeling 
off process which usually lasts from ten days to 
three weeks, the skin often peeling off in great 
flakes. Desquamation is first noticed about the 
face and neck and follows the same order of pro¬ 
gression as did the eruption. 

The diagnosis of scarletina is to be made from 
the history of exposure, high fever, vomiting, 
pharyngitis, characteristic eruption, albumen in 
the urine and a peculiar elevated condition of the 
papilla of the tongue which has given it the name 
of strawberry tongue. Briefly, scarletina is to be 
known from measles by the eruption of the latter 
appearing in blotches and by an absence of the 
catarrhal symptoms usually present in measles. 
From rubella or rotheln it is to be differentiated 


SCARLETIAA. 


by the presence of albumen in the urine, by its 
slower development and in the latter disease a 
lower temperature and less violent sore throat. 
The diseases are frequently confused. A safe 
position should always-be taken where doubt 
exists and the case regarded as scarletina. 

The period during which scarletina is infec¬ 
tious differs according to different observers. 
Most writers, however, agree in placing it from 
the first appearance of symptoms to the .close of 
desquamation and until discharges cease. The 
contagion may remain potent in clothing for 
years. 

The susceptibility of an individual to scarletina 
is much less as compared with small-pox and 
measles, about fifty per cent of the exposed con¬ 
tracting the disease. Opinions differ as to the 
respective susceptibility of the sexes, some 
authors stating that after the first two or three 
years females are more susceptible than males, 
but that the disease proves more fatal to males. 
The correctness of these statements, is, however, 
involved in much doubt. The disease seems to 
be more prevalent in the autumn and '^winter 
months. 

As a sanitary precaution to be observed in all 
doubtful cases of sore throat with fever during 
epidemics of scarletina, the attack should be re¬ 
garded with suspicion. The sufferer from scar¬ 
letina should be isolated in a large, airy,\light 
room from which all unnecessary articles of fur¬ 
niture, clothing, etc., have been removed. The 
word necessary in this connection should receive 
the most absolute interpretation implying there 
should only be left such articles as are indispensi- 
ble to the welfare of the patient. All discharges 
from the nose, throat, eyes, ears, kidneys, bowels. 


»o 


sc VRLF^TIX A. 


etc., should receive a thorough disinfection in 
solutions of chloride of lime, carbolic acid, form¬ 
aldehyde or some equally efficient disinfectant. 
When practicable discharges should be received 
on rags and burned. Antiseptics should be used in 
the throat throughout the attack. Table cutlery, 
glasses, spoons, dishes, etc., should be thoroughly 
boiled. Bedding and clothing when possible 
should be put in some such solution as suggested 
above and boiled for at least twenty minutes. 
Strict quarantine measures should be observed 
and all to whom is granted the privilege of 
passing quarantine lines should be required to 
make complete change of clothing and wash 
hands and faces, including hair and beard, with 
carbolized soap. The quarantine period should 
last seven days from last exposure or during 
the entire infectious period as given above. Bland 
oils or fats and the bath are to be used in the 
period of desquamation to hasten the process and 
prevent distribution of the scales. The physician 
visiting these cases should be required to wear 
the cap and gown described on page 47. Follow¬ 
ing a siege of scarletina the most rigid room 
disinfection should be prosecuted after the man¬ 
ner described in the chapter on Room Disinfec¬ 
tion, and in the event of death the antiseptic 
sheet, or the air-tight casket and the private 
funeral should be brought into service. The use 
of hacks as hearses should not be permitted. 
Immunity for life is usually a result of an attack 
of scarlatina. 


. / 


J)7 


* Rubeola or Measles. 


RUBEOLA OR'MEASLES is* an acute infec¬ 
tious disease characterized by fever, a peculiar 
eruption appearing, on the skin and violent 
catarrhal symptoms prominent among which are 
sneezing, watering of the eyes, and a cough which 
is rather explosive in character. The specific 
cause like that of scarletina has not as yet been 
isolated but from analogy we again assume a 
germicidal origin exists in all cases and we man¬ 
age it as a parasitic affection. ' 

Measles also resembles scarletina in that, it is 
usually classed as a disease of childhood. It dif¬ 
fers,^ however, in two respects. Adults are more 
frequently attacked than is the case in scarletina 
and as a-rule the affection seems to run a more 
violent course in adults than in children. It may 
be stated however that measles is not a common 
occurrence in children under six months of age. 

The infectious principle whatever it may be 
seems to be given off from the skin and dis¬ 
charges from the nose, etc. It may be spread 
through the atmosphere for a short distance, 
hovering over the sufferer as a sort of effluvium 
and may be carried in the clothing although this 
latter mode of transmission is not so marked as in 
scarletina. Indeed it is probably very infrequent 
the disease is carried through the clothing on a 
third person. The infectious principle seems to 
be very diffusible and is of short life in which 
latter respect it again differs from that of scar¬ 
letina. 

Measles usually appears in an endemic or epi¬ 
demic form, recurring in more or less regular 


98 



RUBEOLA. 


cycles of from two to seven years and is most 
common in the winter and spring months. 

The period of incubation in measles varies 

from seven to eighteen days, the longest period 
recorded being eighteen days and the shortest 

at seven days. The average and most usual period 
of incubation is fourteen days, ci ? . r 

The first symptoms to manifest themselves in 
measles are the fever and the catarrhal conditions, 
the eruption usually beginning at night and being 
discovered the fourth day from the onset. The 
eruption is not distinct when it first appears, the 
firsts appearance being on the mucous membrane 
of the mouth, on the forehead, the cheeks and the 
ears. It is.of a macular (blotch) "'character, is 
elevated and ranges from a pale red to a deep red 
color. These blotches or macules are from a line 
to a quarter of an inch in diameter and in many 
cases seem;.to group themselves into crescentic 
figures. .This grouping has been > considered 
characteristic of .measles. The order of appear¬ 
ance of the eruption has been variously t given by 
different authors, most "however, agreeing that 
it spreads from the face to the body on the second 
day and from the body to the extremities'on the 
third day of the eruption. ... !- " ■ 

Instead of the above mentioned grouping the 
eruption j is sometimes found to be confluent in 
character. The eruption.is most intense on the 
second or third day, dating from its "appearance, 
and after this date begins to fade in the order of 
its i appearance. As a rule the temperature will 
be found in-a direct ratio to the rash. ^ The, dis¬ 
appearance • of the eruption, is complete ^usually 
in from‘~four to six days from the appearance 
though occasionally .there presents* protracted 
cases in which it may last as long as ten or twelve 


99 


RUBEOLA. 


days. The desquamation is of a bran-like char¬ 
acter and in some cases is so slight as to be 
scarcely noticeable. This process is usually com¬ 
plete in a very few days, but rnay be prolonged 
over a period of two weeks. 

The diagnosis of measles depends on a history 
of exposure, slow onset, the catarrhal conditions 
and the characteristic eruption which has been 
described above. The diseases with which it is 
most likely to be confused in diagnosis are 
typhoid fever, typhus fever, scarlet fever, rubella, 
smallpox and chickenpox. In typhus and typhoid 
fevers is to be found markedly greater symptom's 
of depression than in measles and the catarrhal 
symptoms of the latter are absent. Scarletina 
was contrasted with measles in describing scar¬ 
letina and the differential diagnosis need not be 
repeated. In both chickenpox and smallpox the 
eruption is of a papular character whilst as above 
stated it is of a macular character in measles. In 
none of the other eruptive diseases is there found 
so violent catarrhal symptoms. Rubella or 
rotheln' is not so easily differentiated but the chief 
points of'difference lie in the lower temperature 
of the latter (though it may be high) less violent 
catarrhal symptoms, eruption not grouped and 
not so distinctly macular, more sudden onset of 
rotheln and the heavily coated tongue of measles 
which is not found in'rotheln. 

Measles is infectious at all periods though 
least so during the stages of incubation and 
of desquamation. The disease is of so highly 
contagious a character that but few who are ex¬ 
posed escape an attack unless absolutely immune. 

As a rule it may be stated that one attack con¬ 
fers immunity throughout life. 


lOOt 


UUIIEOI.A. 


The sanitary measures to be observed are 
similar to those given under scarletina though 
from the fact the contagium does not cling so 
tenaciously to apartments, toys, etc., as in scar¬ 
letina the room disinfection need not be such an 

» ^ I , 

exhaustive process. Usually a thorough cleaning 
using such methods as are commonly employed 
in house-cleaning is all that is necessary. 
Patients should of course be isolated in rooms 
prepared.as for scarlet fever patients. . ^ 
.The .period .of quarantine should cover two or 
three weeks or according to Dr. J.,.N. Hurty, 
fifteen days from last exposure. .5 


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I I 



, Rubella or False Measles, 

c, - 

RUBELLA, ROTHELN OR FALSE MEA¬ 
SLES is an-acute infectious disease resembling 
both^ rubeola (measles) and scarlet fever and yet 
differing from''them in important particulars. It 
is characterized by a fever of sudden onset, a 
maculo-papular eruption, mild catarrhal symp¬ 
toms and a sore throat of moderate severity. In 
the matter of causation the disease occupies ex¬ 
actly the same position as do each of the other 
diseases that have been specially considered, i. e., 
nothing definite is known and yet from its 
phenomena there is a reasonable degree of assur¬ 
ance of germ origin. Most cases of rubella occur 
between the ages of four and fifteen years though 
adults are not infrequently affected. The disease 
resembles measles in that it occurs most fre¬ 
quently in the winter and spring months. 

Opinions differ widely as to the degree of in- 
fectiousn'ess of rubella which is probably high 
though somewhat less than that of scarletina and 
measles. The skin and breath seem to be the 
chief sources of the infectious agent which may 
be carried by means of bedding, clothing, toys, 
etc., but which does not apparently cling to these 
articles with the same tenacity found in the con- 
tagium of scarletina and diphtheria. 

The infectious period extends from the earliest 
manifestation of symptoms throughout the entire 
course of the disease process including the stage 
of desquamation which phenomenon is of a 
branny or furfuraceous character frequently so 
slight as to be scarcely noticeable. The period of 
incubation is somewhat variable, this varience 
being characteristic of the disease, the range of 
varience being from one to three weeks. 


102 



KU BELLA. 


There are but few prodromal symptoms in this 
affection the first indication of disease process 
being found in the slight elevation of temperature 
and the eruption which is usually discovered in 
the morning after having retired in apparently 
good health. The eruption appears first on the 
face but rapidly passes down over the chest, 
entire trunk and extremities so that in a few 
hours it has extended over the entire person. 
The duration of this eruption is short, lasting but 
three or four days, the rash and fever (which 
bears a close relation to the eruption) being at 
the acme by the second day. As before remarked 
the desquamation is but slight and is usually 
complete in from one to three days. 

From its close resemblance in many particulars 
to measles and scarletina rubella has been a 
source of much annoyance to health officers and 
physicians, and indeed in many instances a differ¬ 
ential diagnosis is next to impossible. Particularly 
is this true in differentiating from scarletina. 
The diagnosis depends on the suddenness of 
onset, there being but slight prodromes, if indeed 
any at all are noticed, absence of catarrhal symp¬ 
toms, slight or irregular temperature and the fol¬ 
lowing conditions compared with the symptoms 
of these other diseases. These comparisons are 
given not because of any great importance of 
rubella in and of itself but that the diagnosis is 
important that measles and scarletina may not 
be unrecognized and confused with the disease of 
less importance, thereby occasioning widespread 
epidemics of these affections which are of grave 
significance not only as dangerous and severe 
disease processes but as factors in important 
sequela. 

The period of incubation is longer than that of 
scarletina whilst that of measles is almost univer- 


103 


RUBEIil.A. 


sally fourteen days. The prodromal symptoms 
as' stated above, if not absent ^ entirely are but 
slight whilst in^imeasles they last several days, 
consisting principally of the marked catarrhal 
symptoms. Sore throat is more frequent than is 
found in measles but is not so severe as usually 
attends scarletina. The fever in rubella is usually 
absent or slight but is marked and characteristic 
in both measles and scarletina. 

The eruption of scarletina first appears on the 
neck and chest and spreads slowly. In measles 
and rubella the first appearance is on the face 
spreading gradually in measles and rapidly in 
rubella covering the entire body in twenty-four 
hours. The color of the eruption is a pale red, 
lighter than in measles or scarletina and is not so 
elevated as in either of these affections. Neither 
is any grouping to be found. The tongue of 
rubella is usually but slightly coated, that of 
measles heavily coated and that of scarletina 
showing an elevation of papilla which gives to it 
the name of strawberry tongue. Albumen is 
frequently found in the urine in cases of scar¬ 
letina. This is sometimes the case in measles, 
but almost never true in rubella. In the last 
stage, that of desquamation there is another point 
of difference. In measles- it is of a branny char¬ 
acter ; in rubella slight, absent or branny and in 
scarletina in larger flakes. 

The contagium of rubella does not cling to 
apartments with the same tenacity of that of 
scarlet fever but owing to possibility of confusion 
and error the same methods of disinfection should 
be employed. Quarantine should cover a period 
of about two weeks. As with the other acute 
eruptive diseases one attack seems to render im¬ 
munity for life. 


104 


Parotiditis. 


EPIDEMIC PAROTIDITIS OR MUMPS.— 
This disease is an acute infectious affection 
characterized by a chill, fever, headache and in¬ 
flamed state of the parotid or other salivary 
glands. Usually, however, one or both parotids 
is the site of the inflammation. Under two years 
the disease is of rare occurrence, being found 
most commonly between the ages of five and 
fifteen years. The affection seems to prevail as 
an endemic or epidemic and is unquestionably of 
an infectious origin though no organism has been 
demonstrated to be the specific cause. The con- 
tagium is most probably conveyed through per¬ 
sonal proximity (not necessarily contact) by 
means of the breath — possibly through the 
clothing at times though rarely so. 

The period of incubation varies from one to 
three weeks, the shortest time reported being 
three days, the longest six weeks and the average 
three weeks. The swelling of the glands is 
usuallv preceded by a feeling of malaise, head¬ 
ache, chilliness, fever and occasionally severe 
neuralgic pains. The swelling as a rule involves 
only the parotid glands, but anomalous cases 
arise in which the submaxillary or sublingual 
glands are alone affected or even the testes to 
which organs the disease shows a marked ten¬ 
dency to metastatic change. One gland usually 
precedes the other in the disease process and in 
some cases one gland alone is affected though 
both may suffer at the same time. In cases 
where the disease process is unilateral a second 
attack involving the other gland may occur at 


105 



PAROTIDITIS. 


any time. The swelling of the glands is usually 
at the maximum in from two to four days and 
continues from seven to ten days in cases not 
complicated with metastasis. 

The infectious period probably covers the entire 
course of the disease including the period of in¬ 
cubation and for several days following the dis¬ 
appearance of the swelling. The affection is un¬ 
doubtedly infectious from the beginning of 
symptoms. Quarantine should cover the infec¬ 
tious period and as a sanitary measure the patient 
should be isolated during this time. The con- 
tagium seems to possess such a short life that 
fumigation is considered unnecessary. 



■f i r 




Variola. 


\ __ 

t 

VARIOLA OR SMALLPOX is an acute, 
highly infectious disease characterized by chill, 
fever, severe pain in the back, sore throat, extreme 
prostration and a peculiar eruption which usually 
makes its appearance in from two to four days 
from the beginning of symptoms. Variola always 
proceeds directly or indirectly from a previous 
case though the exact nature of the contagium 
is not known. . 

Age as a factor in susceptibility is not an im¬ 
portant consideration in. smallpox save as is 
apparent from the fact one attack almost without 
exception immunizes-from future attacks for all 
time. Racial differences, however, seem to be 
of somewhat greater importance in the considera¬ 
tion of susceptibility, the dark skinned races being 
more "susceptible than those of lighter hue. Vac¬ 
cination likewise influences susceptibility. This 
phase will be considered later. The lessened 
susceptibility from vaccination hov/ever is not 
necessarily permanent but disappears in time. 
The contagion of variola is quite virulent under 
favorable conditions living as long as two or 
more years. The agent resists drying to a re¬ 
markable degree, a factor which greatly facilitates 
the clinging to articles of clothing or furniture 
and "its distribution in the form of dust particles 
in the atmosphere. The infectious agent which 
is given off freely from the sufferer is usually 
conveyed by means of the air, clothing, bedding, 
personal contact, sputa, excreta from the skin, 
nose, etc., but is soon destroyed in the presence' 


VARIOLA. 


of air and bright sunlight. The usual avenue 
of entrance to the system is the repiratory tract. 

The period of incubation is usually placed at 
ten or twelve days. The shortest period on record 
is eight days and the longest fifteen days, the 
average being twelve. 

The eruption first appears on the forehead, 
temple and wrists and is to be found from the 
second to the fourth day of the disease dating 
from the beginning of symptoms as stated above. 
This eruption in the course of the disease passes 
through a series of changes this successive change* 
being characteristic of the affection and one of 
the diagnostic features. The eruption appears to 
manifest a preference for exposed surfaces. The 
first appearance of the.eruption is deep down in 
the skin and presents a hard, sort of shotty feel¬ 
ing. There is at first but little elevation above 
the surrounding healthy skin but by rthe third 
day these points have become elevated, passing 
through a papular stage and at this time being 
crowned with minute little blisters or vesicles 
which are filled with a straw colored fluid. These 
blisters or vesicles as they are more properly 
called soon become depressed in the center and 
are then said to have become umbilicated. In the 
few succeeding days the serum becomes some- 
what clouded and the vesicles degenerate into 
pustules beginning by the eleventh or twelfth 
day the process of desiccation or drying up. After 
the healing process is complete! the scabs 'drop 
off and the skin presents a red mottled appear¬ 
ance which gradually fades leaving a healthy 
appearing skin or the scar. 

Since in the eruptive stage of variola there is a 
destruction of tissue/it necessarily follows that 

lOS 



Fisfure XXXII. 
Variola. 








VARIOLA. 


those dying of smallpox must show the presence 
• of these papules, vesicles, or pustules, minus of 
course a certain amount of color due to the 
absence of the blood. 

To diagnose smallpox one must depend on the 
above mentioned characteristic symptoms, a his¬ 
tory of exposure and no history or evidence of a 
recent or successful vaccination. 

Authors differ as to just the extent of the period 
of infection. The disease is certainly most infec¬ 
tious during the period of vesicular and pustular 
eruption and during dessication and dropping off 
of the scabs. To be on the safe side however 
one should regard the period of infection as be¬ 
ginning with the first manifestation of symptoms 
and closing with a healthy skin and proper disin¬ 
fection. 

The sanitary measures which should be re¬ 
quired consist in prompt isolation and strict quar¬ 
antine covering the entire period of incubation 
and infection, absolute cleanliness, disinfectant 
washes for discharges of nose, eyes, mouth, etc., 
carbolized oil or vaseline for scaling off period, 
the most rigid room and personal disinfection as 
set forth on pages 43 and 62, the most rigid en¬ 
forcement of sanitary rules in preparation of the 
corpse in infectious cases (see Chapter VII) and 
vaccination and revaccination. The patient should 
be given antiseptic baths and all clo^thing, etc., 
should be properly disinfected, boiling when pos,- 
sible in antiseptic solutions. The period of quar¬ 
antine should extend to fifteen days from last 
exposure or should cover the entire infectious 
period. One attack usually confers immunity 
for life although there may be exceptions to this 
rule. 


110 


Varioloid. 


VARIOLOID is a modified form of smallpox 
occurring in individuals who have been vac¬ 
cinated successfully, not as a result of the vaccina¬ 
tion but as the result of an exposure to smallpox, 
the vaccination occupying only a^modifying not 
a causative relation in any instance.. The disease 
is mild in its manifestations but should receive 
careful and rigid sanitary considerations since the 
differential diagnosis is not always easy and since 
above all other reasons from this mild form of the 
affection known as varioloid a true case of small¬ 
pox (variola vera) may result. All that has been 
said relative to the sanitary measures and pre¬ 
cautions to be observed in dealing with smallpox 
applies therefore with equal force in varioloid. 

Bodies dead from smallpox or varioloid are 
potent factors in disseminating the disease and 
should therefore be thoroughly disinfected by 
proper embalmment and thorough soaking in an 
antiseptic solution, for which purpose there is 
probably nothing superior .to bichloride of mer¬ 
cury in the proportion of one ounce to the gallon 
of water or.five ounces of chloride of lime in one 
gallon of water used on a heavy layer of absorb¬ 
ent cotton. In all cases the body should be 
wrapped in the antiseptic sheet or blanket observ- 
ing great care that the v/ork is done thoroughly. 


i 


111 



Vaccinia, 


VACCINIA is an 'inoculable disease trans¬ 
mitted in no way save by inoculation and charac¬ 
terized by fever, pain and the formation of a 
pustule which has passed through a papular and 
vesicular stage. These pustules occur at each 
point of inoculation. The course of vaccinia is 
remarkably regular when uncomplicated by 
mixed infection or impure virus. In vaccinia is 
found our most efficient means of prophylaxis 
against smallpox. 

The complete history of vaccination as a pre¬ 
vention of smallpox is too voluminous to be 
given. Suffice it to say the first practical demon¬ 
stration of method — much the same as at pres¬ 
ent though improvements have been added — and 
efficiency was made by Jenner in May, 1796. No 
germ has been isolated and proven to be the 
cause of vaccinia but that such an organism exists 
seems more than probable. The discovery of the 
efficiency was purely a matter of observation. 
Dairy hands contracted an affection (vaccinia) 
from cows suffering from what is known as cow- 
pox. Later it was observed those who had been 
so affected possessed a relative degree almost an 
absolute degree of immunity from smallpox and 
from this observation the present system of vac¬ 
cination against smallpox has developed. There 
are those who believe and advocate that cow-pox 
is smallpox in the bovine, whilst others claim it 
is quite a different disease. Acting on the first 
theory certain scientists have modified smallpox 
by passing its virus through bovine animals, a 
process which seems to lower its potency, and 


112 



VACCINIA. 


from the virus thus obtained have successfully 
vaccinated against smallpox. Others have not 
failed in the desired end of an immunity against 
smallpox, but unfortunately have attained such 
immunity by inducing the true smallpox through 
an inoculation with such modified ( ?) virus. The 
safe plan is to use no such virus until thoroughly 
tested and proven to be identical with true vac¬ 
cinia of the heifer. 

No symptoms are manifest for the first few 
days following a vaccination (which should be 
from a sealed tube of sterile virus) other than 
those attendant on a slight abrasion of the skin. 
By the third or fourth day a slight redness is 
discernible at' the point at which the virus was 
introduced.' This redness gradually increases 
and a papule is formed which by the fifth day 
should begin to be vesicular. By the eighth day 
the vesicle should have become mature and 
should be umbilicated as are the vesicles of small¬ 
pox. Desiccation then begins and by the end of 
the second week there is usually a perfectly dry 
scab which however may not drop off for another 
week or even longer. The scar is frequently 
pitted. 

The dangers of vaccination have been heralded 
widely but as a matter of fact where pure virus is 
used, care being taken to prevent a mixed infec¬ 
tion, the danger of inducing any other disease 
than vaccinia which is sought is practically nil. 
In a somewhat extended experience I have never 
found a case in which the symptoms of vaccinia 
were at all alarming notwithstanding the fact 
cases have been under observation including both 
extremes of age. Cases have been reported where 
arms and life were in danger but on investigation 
I have found the danger to exist chiefly in an 


11.3 


VACCINIA. 


over-wrought state of the patient’s nerves. I 
doubt not the reliability of certain reported cases 
in which life or limb or both have been sacrificed 
but in such instances if one could only get at the 
facts I am convinced the fault lies either in impure 
virus, faulty methods of operating or carelessness 
in the after treatment. A vaccination is a surg¬ 
ical operation and should be treated as such, all 
precautions of asepsis being observed both at the 
time of operation and in the necessary care to fol¬ 
low. Any one who fails to recognize these facts 
and to act accordingly should not assume the re¬ 
sponsibility of the operation. Human virus i. e. 
virus taken from another patient’s arm or scab 
should not be used. Cleanliness is the essential 
sanitary precaution to be employed and when 
pure virus is used and surgical cleanliness ob¬ 
served throughout the entire course I have no 
hesitancy in stating there is no danger. Even 
when the ordinary methods and care are employed 
the dangers are in no degree comparable with 
those of smallpox. 



Varicella or Chickenpopi. 


VARICELLA OR CHICKENPOX is a dis- 

* * 

ease heretofore considered' of little significance 
owing to the mild train of 'symptoms usually 
manifest. Of later years though the affection 
has come to demand more attention owing to the 
occasional severity of symptoms and the fre¬ 
quency with which it is confused with smallpox. 
Varicella is characterized by a short fever of a 
mild type accompanied by an eruption appearing 
in a succession of crops, the eruption being of a 
vesicular type. Varicella stands in the same class 
as measles and other eruptive diseases that have 
been considered, as regards causation no specific 
agent having been positively identified and yet 
the course of the disease being such as to confirm 
one in the belief of a parasitic origin. Most cases 
of chickenpox occur between the ages of one and 
ten years, often the disease being found in chil¬ 
dren under six months of age and occasionally an 
adult being affected. After ten years of age the 
susceptibility seems to lessen somewhat, but not¬ 
withstanding this fact and that one attack usually 
confers immunity for life in rare instances an 
individual suffers from a subsequent attack. In 
these cases of subsequent attacks of varicella the 
symptoms are frequently so mild as to not attract 
much attention. However, this may quite as 
truthfully be said of many of the primary cases. 

Two or more weeks is the usual period of in¬ 
cubation, the shortest period coming within my 
knowledge being thirteen days and the longest 
nineteen days. Fourteen days , constitute the 
average duration of incubation. 

The eruption which is frequently the first 
symptom appears in the form of a macule, but 


115 



VARICELLA. 


soon changes to a vesicle or blister., The con¬ 
tents of this vesicle, a clear serum, is soon ob¬ 
served to become clouded or milky though it is 
never of so. distinctly purulent a type as is 
found in the pustules of variola vera (smallpox). 
There is a gangrenous form of the disease how¬ 
ever in which a part of the vesicles degenerate 
into deep phagedenic ulcers extending down even 
through the skin and sometimes involving mus¬ 
cular tissue. The average size of the vesicles in 
an ordinary case of chickenpox is about one- 
eighth of..an inch or equal to a split pea. The 
eruption of chickenpox appears in a succession 
of crops and not simultaneously as in smallpox, 
this being one of the characteristic symptoms. 
Some vesicles have begun to dry when others 
are but appearing in the macular stage. In fact 
all stages of the eruption are to be found at one 
time in the same case. .There is no umbilication 

• '.1 4 

in the eruption of varicella, such as is found in 
the eruption of smallpox. There is though a sort 
of depression found in the vesicle in the stage of 
desiccation, but this depression is due to the dry¬ 
ing and not to any binding down by means of 
bands of connective tissue as in smallpox. The 
eruption .occasionally appears on the mucous 
membrane of the mouth and of the genitalia, but 
never on the conjunctiva and seldom or never on 
the palms of the hand or soles of the feet. 

A differential diagnosis from variola is to be 
made and depends on the above phenomena and 
the following distinctive symptoms. In smallpox 
as before mentioned the eruption has a hard 

a. i 

shotty feel, even before it has thoroughly ap¬ 
peared on the surface. This hard shotty sensa¬ 
tion to the touch is not to be found in varicella as 
a rule. The severe pain in the back found in 
smallpox is wanting in chickenpox. There is in 

lie 


VARICELI.A. 


this latter affection usually an absence of the 
severe constitutional disturbances of smallpox. 
Next to be considered or perhaps I had better 
say the first consideration in differentiating be¬ 
tween smallpox and chickenpox is the history of 
the case and presence or absence of evidence of a 
successful vaccination, since vaccination renders 
a comparative immunity from smallpox. In 
chickenpox the eruption is greatest in those parts 
of the body covered with clothing whilst in small¬ 
pox the exposed parts i. e. the face and hands are 
most affected. The eruption of smallpox reaches 
a pustular stage. That of chickenpox does not. 
In smallpox the eruption is also slower in its 
development and spreading never appearing in a 
succession of crops such as is found in chicken- 
pox. The eruption of smallpox" is likewise more 
uniform in size. 

Varicella or chickenpox is highly contagious 
from the earliest manifestation of the eruption 
until it has completely disappeared. This entire 
period of infectiousness should be under quar¬ 
antine restrictions. Where one is held in quar¬ 
antine in the expectancy of an attack following 
exposure the quarantine restrictions should be 
removed in nineteen days from the last exposure. 
As stated above one attack usually confers im¬ 
munity. Where death occurs, as it sometimes 
does in the gangrenous form of the disease, the 
corpse is necessarily marked since there is in the 
vesicle a certain amount of tissue destruction. 
There is no special form of treatment required in 
these cases other than an application of the rules 
of sanitation which apply to the communicable 
diseases in common including prompt burial and 
the antiseptic sheet in all cases where the diag¬ 
nosis is at all a doubtful question. 


117 


Pertussis or Whooping Cough. 

i 


PERTUSSIS OR WHOOPING COUGH is 
acute infectious disease characterized by 
bronchial, laryngial and nasal catarrh and a 
paroxysmal cough. Most cases occur within the 
first six years of life and of these more than fifty 
per cent before the fourth year. Cases occurring 
before the sixth month are not uncommon. The 
affection is not often met after the tenth year 
though occasionally a case is found in the adult. 
Two reasons may be assigned for the above facts 
regarding the age of patients affected. First, 
most children are exposed before the sixth year 
and second, susceptibility seems to lessen after 
the tenth year. Although a matter of some doubt 
the causative agent is again presumed to be mi- 
crobic in character, the disease process so closely 
conforming to other disease processes known to 
be of bacterial origin. The bacillus tussus con- 
vulsivae has been assigned as its cause but is 
somewhat lacking in proof. The agent is trans¬ 
mitted from the respiratory tract by means of the 
breath and the secretions of the mucous lining of 
the respiratory passages. A rather close contact 
seems to be essential though this need be only 
for a comparatively short time. In rare instances 
the infection may have been carried on clothing 
though this is unusual. 

The diagnosis of whooping cough is dependent 
largely on a history of exposure and the presence 
of a markedly paroxysmal cough, the paroxysms 
not infrequently lasting for several minutes and 
being so severe as to occasion a rupture of small 
blood vessels in the mucous membrane of the 


118 



I»EUTUSSIS. 


nose or eye. The cough is characterized by a 

sort of whistling sound on inspiration which 

sound has given the affection the name whooping 

cough. Pertussus is infectious during the entire 

period of catarrhal symptoms, lasting in ordinary 
♦, 

cases from six to eight weeks. 

Various estimates have been placed on the 
period of incubation ranging from two to twenty- 
one days. The average term of incubation, how¬ 
ever, is from three to seven days. In all cases 
the quarantine should be maintained throughout 
the entire infectious period and some even urge 
its continuance until all cough has ceased even 
if it should return. The patient should be isolated 
and following the attack the rooms occupied 
should be disinfected according to the general 
rules for room disinfection. The disease is more 
dangerous than is generally supposed and for 
some unaccountable reason more fatal to Negroes 
than others. One attack usually confers im¬ 
munity. 



: 1 !'■ i 



'Diphtheria. 


DIPHTHERIA is an acute, highly infectious 
disease characterized by fever, prostration and a 
sore throat in which is found a grayish white 
exudate or pseudo membrane. The disease may 
be endemic or epidemic and occasionally a 
sporadic case is found. The origin is unques¬ 
tionably a micro-organism, the Klebs-Loeffler 
bacillus having been demonstrated to be the 
specific .cause of the affection. Diphtheria is 
usually classed with the eruptive diseases not¬ 
withstanding the fact there is no eruption. There 
is however a local manifestation and constitu- 



/ - 

Figure XXXIII. 

Bacillus diphtheria. 



tional disturbance. The morphology and staining 
methods of the bacillus diphtheria are not essen¬ 
tial in this connection since they are found 
in any standard work on bacteriology. Suffice it 
to say in relation to this organism that a low 
temperature, moist air and darkness seem to pro¬ 
tect the life of the organism and hence diphtheria 
is more common in the spring and winter months. 
For obvious reasons cellars and basements are 
favorable to the disease. 

Sex does not seem to be an important consid¬ 
eration in diphtheria, the sexes being attacked 


13rt 



DIPHTHERIA. 


with about equal frequency. Most cases occur 
before the age of fifteen, although cases are 
by no means infrequent after this age and in fact 
even in adult life. 

It will be readily understood from what has 
been said above that no case of diphtheria can 
arise de novo. If the complete history could 
always be ascertained one might in every instance 
be able to trace infection to a previous case of 
diphtheria. Cases of apparently simple tonsilitis, 
nasal ulceration or ozena are not infrequently 
diphtheritic in character and furnish the required 
infective agent. Cats, pigeons and fowls suffer 
from throat affections of a diphtheritic character 
and are doubtless frequent factors in the spread 
of diphtheria. But recently four cases, one of 
which was fatal, came under my observation in 
which the infection was traceable to a dog. 
Another manner of spreading the infection 
of diphtheria is through milk which has been 
infected from affected persons employed in the 
cow-sheds, dairies, etc. Fomites, i: e., bedding, 
clothing, carpets, books, toys, spoons, forks, etc., 
constitute another source of infection which is 
most potent. From this statement it will be seen 
diphtheria may also be contracted from a person 
who has been in contact with a case of diphtheria 
who has not himself contracted the disease. In this 
manner physicians have carried the disease from 
house to house in making their rounds, little or 
no attention having been given to personal disin¬ 
fection as outlined in chapter five. It is needless 
to add such a practice is nothing short of inhuman 
if not criminal. Defective sanitary conditions 
may be mentioned as a predisposing factor in the 
causation of diphtheria acting as such by engen¬ 
dering morbid,conditions of the upper respiratory 


121 



DIPHTHERIA. 


passages favorable to the growth of the diph¬ 
theria organisms when implanted thereon. 

The period of incubation has a very consid¬ 
erable range of variance extending from an indefi¬ 
nitely short period up to seven days the average 
term being two days. 

The diagnosis of diphtheria though of inestima¬ 
ble importance and a matter which may be made 
an absolute certainty is frequently in doubt. The 
points on which certainty of diagnosis depends 
are a history of exposure, the presence of grayish 
white adherent patches of a pseudo membrane in 
any part of the upper respiratory.passages, (par¬ 
ticularly other parts than on the tonsils) and in 
chief the presence of the bacillus of diphtheria as 
shown by the microscope. This latter is the posi¬ 
tive diagnostic feature. The membrane above 
mentioned is composed of partially organized 
lymph and necrotic epithelial tissue. 

Throughout the entire course from the first 
manifestation of symptoms (perhaps from first 
exposure) till the bacilli have disappeared from 
the throat diphtheria is contagious. By some it 
is even supposed to be contagious during the in¬ 
cubative period. This period during which the 
infectious agents may be given off may cover as 
much as six or eight weeks, dating from the be¬ 
ginning of the attack. 

Susceptibility seems to lessen somewhat after 
the fifteenth year of age and for some months 
after an attack. The most rigid sanitary measures 
are to be enforced in dealing with diphtheria. 
Complete isolation of the patient is the first con¬ 
sideration and this isolation should continue 
throughout the entire period of infectiousness. 
The mouth, nose and throat not only of patient 
but of any one who has been exposed should be 


122 


DIPHTHERIA. 


cleansed thoroughly and at frequent intervals for 
which purpose should be used an antiseotic wash 
or spray such as may be prepared from Dr. 
Seiler’s alkaline and antiseptic tablets or a satur¬ 
ated solution of boracic acid. The granular form 
of the acid is to be preferred for this use since it 
forms solutions much more readily than the pow¬ 
dered form. Immunizing doses of antitoxine 
should be used. Glasses, spoons, cups, knives, 
forks, plates and all other such articles used by 
the patients should be thoroughly boiled or 
otherwise disinfected before being used again. 
There should be no eating or drinking in the room 
occupied by the patient. The personal disinfec¬ 
tion should be the most rigid, as before outlined, 
and should be required of all quitting the room. 
Discharges from the nose and mouth should be 
received in cloths or rags which should be burned 
at once. All clothing, bedding, towels and similar 
articles should be immersed in antiseptic solutions 
before removal from the sick room. A strong 
solution of chloride of lime or a carbolic solution 
of four per cent answers admirably for this pur¬ 
pose. Later these articles should be boiled for 
not less than thirty to forty minutes. Discharges 
from the rectum or bladder should be received in 
a strong solution of chloride of lime or formalde¬ 
hyde. A strict watch should be observed, par¬ 
ticularly where the patient can not be isolated.. 

Subsequent to diphtheria the room, clothing 
and other infected articles should receive a most 
careful disinfection after the manner outlined in 
the chapter on room disinfection. Directions for 
a sanitary funeral have also been outlined and 
need not to be repeated. The person in charge 
should however keep in mind that too much pre¬ 
caution can not be taken in these matters and 


123 


DIPHTHERIA. 


where any doubt exists nothing of a prophylactic 
nature should be left undone. 

The quarantine restrictions should be in force 
from exposure until the microscope shows the 
throat to be free from the organisms and until 
proper disinfection has been secured. 

One attack does not afford protection against 
subsequent attacks though it does probably 
lessen susceptibility to a degree for some months. 
In discussing this point, however, L. E. Holt, 
(N. Y.) says: “Second attacks of diphtheria, 
while more frequent than those of measles or 
scarlet fever, are relatively rare. In my own ex¬ 
perience, however, I can recall but very few in¬ 
stances of second attacks. R. W. Parker, (Lon¬ 
don) believes the protection afforded by one 
attack to be quite as complete as that of measles 
or scarlet fever.” 


“MEMBRANOUS CROUP,” quoting from the 
Indiana State Board of Health, “is diphtheria of 
the larynx, is more fatal than ordinary diph¬ 
theria and requires extraordinary care.” 




Typhus FeVer 


TYPHUS FEVER, hospital fever, ship fever 
or jail fever, also known by several other names, 
is an acute infectious disease characterized by 
sudden onset, fever, a macular rash, pronounced 
nervous manifestations and a crisis. The affection 
is acompanied by great prostration and is re¬ 
garded as highly contagious. Notwithstanding 
the violent course of clinical phenomena on post¬ 
mortem examination are found no special lesions 
other than a general hyperaemic condition of the 
viscera and a softened, degenerated heart struc¬ 
ture. The disease has not been of frequent oc¬ 
currence of late years but is sometimes found in 
densely populated districts. 

The specific cause of typhus fever is undoubt¬ 
edly a micro-organism although it has not as yet 
been identified. Filth, bad food, overcrowding, 
intemperance and fear act as predisposing 
causes. Strange as it may seem fear is an im¬ 
portant-consideration in the susceptibility of an 
individual to any disease process. I can only 

account for this fact on the theory that fear is 

• • 

depressing and hence lessens the resisting powers 
of an individual. 

The disease is but seldom found in one under 
ten years of age or over sixty-five and where 
found under ten years the process is usually mild 
and rarely fatal. The contagion of typhus fever 
is given off from the respiratory passages and as 
a sort of effluvium from the body much the same 
as" in measles. The intestinal discharges are 
thought by some to be infectious. Apartments, 
clothing, etc., may become infected though the 


125 



TYPHUS FEVER 


infection must be profound to be transmitted by 
means of fomites. A direct contact, however, is 
not essential, simply being in the presence of the 
disease often being sufficient for a transmission. 
The period of incubation is usually estimated at 
from eight to twelve days though a few have 
placed it as lowias one day or even less, o 

As stated above the eruption of typhus fever is 
macular in character. It usually appears on the 
fourth day but may be as late as the sixth or 
seventh and lasts from one to two weeks. The 
chest and abdomen first show the eruption being 
followed by the arms and thighs, the face and 
neck not often being involved. In appearance 
the eruption resembles most that of measles and 
sometimes even presents the grouping found in 
the latter affection. In measles, however, the 
face and neck are early involved and are distinctly 
covered with the macules. The eruption does not 
appear in successive crops as in typhoid fever. 
True petechia representing subcutaneous ecchy- 
moses appear and can not of course be effaced 
by pressure. 

The eruption is one of the chief symptoms on 
which reliance is to be placed in making a diag¬ 
nosis. The affection must be differentiated from 
typhoid fever, meningitis and measles with which 
affections it may be confused. The temperature 
of typhus fever does not present the wave line 
usually present in typhoid fever. Neither do we 
find the abdominal symptoms characteristic of 
the latter affection. The eruption does not appear 
in successive crops as in typhoid and is of a more 
distinct and lasting type than is found in typhoid. 
Epistaxis may be found in either affection though 
it is usually suggestive of typhoid rather than 
typhus. In differentiating from measles age and 


126 


TYPHUS FEVER. 


the catarrhal symptoms are the chief points to 
be taken into account other than the usual 
absence of eruption from the face and neck in 
typhus fever. Meningitis and typhus fever are 
more likely to be confused. In meningitis, how¬ 
ever, the cerebral symptoms are earlier and more 
marked while in typhus the muscular^ rigidity of 
meningitis is wanting The hyperaesthesia is not 
so marked in typhus fever but the temperature 
runs a higher course 

The disease is probably not infectious till the 
end of the first week but this is not a well estab¬ 
lished fact and is therefore a theory on which it 
is not safe to rely. There is also some question 
as to the power of a body dead of typhus fever 
(not typhoid fever) to supply infection but since 
this too is not a known fact and since there is 
no good reason why such a corpse should not be 
disinfected it should be regarded as infectious. 
The safe view of the period of infection then is 
that it covers the entire period of the disease 
which is usually two or three weeks and that 
quarantine measures should be enforced through¬ 
out this period and until proper disinfection has 
been accomplished. 

The sanitary measures to be observed are 
quarantine, isolation of patient, and room and 
corpse disinfection as outlined previously. 

In regard to immunity second and third attacks 
do occur but are not frequent. 




Typhoid FeVer. 


f^i'f 


TYPHOID FEVER or enteric fever is an 
acute disease characterized by a tumefaction and 
ulceration of the lymph follicles of the intestinal 
tract, inflammation of the mesenteric glands, 
profound prostration, fever, eruption, tympanites 
and abdominal tenderness particularly over the 
right iliac region. The sanitary features of 
typhoid are so extended they must be mentioned 
only in outline. Typhoid is peculiarly a disease 
of temperate climates and prevails in the autumn 
months, a hot dry season favoring its develop¬ 
ment. Heavy rains, however, may be an import¬ 
ant factor in cavvymg the infection into new 



Figure XXXIV. 

Bacillus Typhosus. — Lower segment 
showing flagella through special staining 
of Loffler. 

fields. From a sanitary point of view sex is not 
so important an element of consideration as age, 
the sexes being about equally susceptible. Infants 

A 

and adults over fifty-five or sixty years of age are 
but seldom affected. 

Typhoid is practically never transmitted 
through the atmosphere, the usual source of in¬ 
fection being contaminated water or food, par¬ 
ticularly water. Flies may be carriers of infec¬ 
tion from the sick room to food or water. Oysters 
fattened in water contaminated with sewage are 


128 


TYPHOID FEVER. 


said to be a potent factor in the dissemination of 
typhoid. Typhoid is recognized as a disease of 
filth, bad sewers and accumulations of putrefac¬ 
tive material favoring the growth and spread of 
the infective agents. The specific cause of 
typhoid fever is a micro-organism known as the 
bacillus typhosus. 

The period of incubation usually lasting some 
two or three weeks is characterized by a sense of 
languor or malaise. The shortest period of incu¬ 
bation reported is seven days, the longest twenty- 
three days and the average usually being placed 
at twelve or fourteen days. 

The eruption of typhoid fever varies widely 
in different cases. It may consist of only a few 
scarcely noticeable spots or may be profuse even 
rivaling that of measles or it may occupy any 
intermediate station between these extremes. 
The usual eruption, however, is quite insignifi¬ 
cant and often overlooked. It is a rose colored 
rash which makes its appearance toward the end 
of the first week. It appears in a succession of 
crops. 

The diagnosis of typhoid fever during epi¬ 
demics is comparatively easy, depending on his¬ 
tory of exposure, malaise, characteristic tempera¬ 
ture curve, tenderness in right iliac region, 
diarrhoea, rash, tympanites, odor, prostration, 
delirium, etc. In isolated cases the diagnosis is 
more of a problem and if one depends wholly on 
the clinical picture can not usually be made with 
certainty under from five to seven days. The 
chief confusion is with malarial infections. A 
blood examination and the microscope usually 
are conclusive even in cases where the clinical 
picture is not decisive. 

The contagious period covers the entire course 
of the disease which is from three weeks to an 


129 


TYPHOID FEVER. 


indefinite time depending on the severity of the 
attack, the number of relapses, etc. 

Sanitary precautions are numerous. Rubber 
coverings for the mattress are very desirable, al¬ 
most essential to protect from discharges. A 
daily change of bed linen arid clothing, oftener if 
soiled, is of prime importance. In handling these 
articles they should be placed in a strong anti¬ 
septic solution before removing from the room as 
provided in discussing diphtheria. All feeding 
utensils and similar articles should be thoroughly 
boiled before using again. Discharges from the 
rectum or bladder should be received in an anti¬ 
septic solution and should remain in this solution 
for at least one hour after thorough mixing. 
Body and room disinfection as before provided 
should be employed. It is not necessary ordi¬ 
narily in these, cases .to employ the antiseptic 
sheet in which to wrap the body but the orifices, 
particularly the rectum, should be closed and the 
body should be thoroughly washed in a strong 
antiseptic solution. Those nursing patients suf¬ 
fering from typhoid fever or handling the in¬ 
fected clothing, or bodies dead from typhoid 
should never put the hands to the mouth without 
a previous careful disinfection. .The infection of 
typhoid fever is taken into the system in all in¬ 
stances through the alimentary tract. 

Carbolic acid, bichloride of mercury, chlorine 
(chloride of lime) and formaldehyde form a list 
of most desirable disinfectants in typhoid cases. 

Quarantine should include the entire period of 
infectiousness when employed though usually 
quarantine measures are very lax if employed at 

kll. 

One attack usually confers immunity though 
there are exceptions to this rule. 


130 


1 


Cerebro-Spinal Meningitis. 


EPIDEMIC CEREBRO-SPINAL MENIN¬ 
GITIS OR SPOTTED FEVER is an acute in- 
factious disease characterized by an inflammation 
of the membranous inner coverings of the brain 
and spinal cord, the clinical picture presenting 
marked disturbance of the cerebro-spinal func¬ 
tions with a tendency to speedy death. Like most 
of the foregoing affections no specific micro¬ 
organism has been demonstrated to be the excit¬ 
ing cause of spotted fever and yet through 
analogy we again assume that such a cause 
exists. Indeed different organisms have been 
assigned as the cause, but authors and investi¬ 
gators do not fully agree as to any one or group 


^ ^ ^ 

^ <SS> <3S> 

Figure XXXV. 

Micrococcus Lanceolatus Encapsulatus. 


and no one answers to all the various laws of 
proof as given in Chapter I. The micrococcus of 
lanceolatus encapsulatus is universally present in 
these cases but is also found in healthy indi¬ 
viduals. This fact does not necessarily imply it 
may not be the specific cause of the disease, how¬ 
ever, and indeed it is most probable the above 
germ is responsible for the disease process, the 
fact that some individuals contract the affection 
and others do not being accounted for in a dif- 


131 



EPIDEMIC CEREBRO-SPINAD MENlNCilTIS. 


ference of resisting power. All influences that 
tend to a lowered vitality and resisting power 
including fatigue, over-crowding, foul water, 
exposure to cold, moisture and like agencies may 
be listed as predisposing causes. The prevalence 
of these above mentioned conditions doubtless 

accounts for the epidemic feature of the disease. 

-«. 

Most cases occur before the fifth year and in 

r 

the first year the disease seems to be markedly 
more fatal. Doubtless this greater mortality rate 
of the first year is due to the feeble powers of re¬ 
sistance of this period. In^the adult males are 
more frequently affected than females. This 
difference is probably due in some measure to 
greater exposure of males. 

The clinical picture is not at all uniform in all 
cases, the eruption sometimes not appearing at 
all and in some cases extravasations occurring. 
The period of incubation is a matter of some un¬ 
certainty many widely varying estimates having 
been placed. Most authorities, however, seem to 
agree on an incubation period of from eight to 
ten days. 

The manner and source of infection are also 
quite indefinite and must probably remain so 
since the most probable causative agent is so fre¬ 
quently found in healthy individuals. The diag¬ 
nosis of spotted fever is essentially a matter of 
close observation depending on the suddenness 
of attack, vomiting, pain, the eruption, muscular 
rigidity and prominent cerebro-spinal symptoms. 

The disease is probably not so highly con¬ 
tagious as at one time supposed and isolation of 
the patient with good ventilation are practically 
the only sanitary precautions essential. 

Immunity does not necessarily follow. 




132 


^ Erysipelas. 

ERYSIPELAS, ROSE or St. Anthony’s Fire 
is an acute infectious disease characterized by a 
violent inflammation of the skin with fever and a 
general constitutional disturbance. A micro¬ 
organism known as the streptococcus erysipelatos 
is the specific cause of erysipelas (see figure IV). 
As predisposing or contributory factors may be 
mentioned again any thing that will exhaust 
energy including alcoholic indulgence, and ex¬ 
posure. Wounds of the skin or mucous mem¬ 
branes are important factors in the causation of 
erysipelas since they furnish ready avenues of en¬ 
trance for the bacteria. The disease process may 
be established however without any apparent 
abrasion owing to a diminished resisting power of 
the skin. In such cases though there is always 
the possibility of abrasions that are so insignifi¬ 
cant as to have been overlooked. A moist atmos¬ 
phere and a comparatively low temperature are 
favorable to the growth and development of the 
organisms which occasion erysipelas, but in the 
dry form they retain their vitality for long periods 
of time — even for years— and may be carried 
as dust particles for a considerable distance in 
the air and on clothing, no doubt in this manner 
occasioning more or less widespread epidemics of 
erysipelas in hospitals. A direct contact or an 
indirect contact by means of an operator’s hands 
may also be a means of transmission. 

Erysipelas is usually found affecting indi¬ 
viduals of early adult life and seems to be slightly 
more frequent in males than in females. This 
predilection for males is doubtless due to the 
greater exposure and more common indulgence of 
males in alcoholics. 


1S3 



ERYSIPELAS. 


Incubation is again a matter of considerable 
uncertainty varying from one to fourteen days. 
The eruption is an early symptom and ranges 
from the blush of pink to a deep red. There is a 
tendency to spread rapidly. The color may be 
effaced by pressure but returns immediately on 
removal of the pressure. The skin is hot and 
tumefied owing to an infiltration of the subcutane¬ 
ous tissue which is also involved in the inflamma- 
■( 

tory process. The margins of the affected area 
are usually well defined. The duration of ery¬ 
sipelas is variable, lasting from a few days to 
weeks. As a rule it may be stated improvement 
is not to be expected under five days. 

The diagnosis of erysipelas is to be made 
through the microscope and from the clinical 
picture presenting the above described local con¬ 
ditions, heavily coated tongue, headache, chill, 
fever and frequently a sore throat. 

Erysipelas is communicable throughout the 
entire course of the disease. Susceptibility seems 

to increase with each attack rather than to dimin- 

» 

ish. Many different varieties of erysipelas have 

4 

been named, particularly among the laity, but all 
are .erysipelas and differ more in degree than in 
quality and all are no doubt due to the same 
specific cause. 

The sanitary precautions to be observed call 
for isolation of the patient (particularly is this 
essential in hospital cases), personal disinfection 
of nurses, physicians and all connected with the 
case, clothing and bedding to be placed in anti¬ 
septic solutions before being removed from the 
bed chamber, infected dressings to be burned and 
a thorough disinfection of furniture and room 
according to methods before outlined. 


134 


Syphilis. 


i 


SYPHILIS OR POX is an infectious disease 
pursuing a very chronic, irregular course, char¬ 
acterized in acquired cases by an initial ulcer 
followed by varying eruptions and organic disease 
of almost every organ of the body. 

If We may judge by analogy syphilis is most 
probably of bacterial origin for like diseases 
known to be due to bacterial invasion the affec¬ 
tion presents stages of incubation, aggression, 
decline and immunity. The exact micro-organism 
occasioning syphilis has however not as yet been 
demonstrated. 

Syphilis may be either inherited or acquired, 
inherited syphilis manifesting itself in develop¬ 
mental changes of structure and lowered vitality 
and the usual symptoms of syphilis to be found in 

' t ,. 

the tertiary stage. Very possibly many of these 
cases have acquired syphilis while in utero. Pa¬ 
ternal syphilis is, however, frequently manifest in 
the child. Acquired syphilis is usually of a direct 
venerial origin though infection may and doubt- 
less does frequently occur in other mariner. For 
example the hand of the physician, surgeon or 
embalmer (though some contend a body dead of 
syphilis will not infect) may be inoculated while 
engaged in the performance of his professional 
duties. Dental instruments may be agents in the 

f 

spread of syphilis as may public .drinking ves¬ 
sels; or the disease may be transmitted through 
kissing. Pipes have been agents of transmission. 
In short any means by which infected blood or 
syphilitic virus may be carried to an abraded skin 


13.'> 



SYPHILIS. 


or mucous membrane may be a source of infec¬ 
tion. 

Incubation is usually a matter of about three 
weeks from infection to the appearance of the 
initial ulcer though it sometimes is. as short as 
ten days or may be prolonged for three months. 
The ulcer which lasts from two to twelve weeks 
is followed by eruptions which vary from macules 
to papules and pustules. This period of eruption 
in which the mucous membranes and frequently 
the hair are involved also is known as the sec¬ 
ondary stage. This stage is preceded by what is 
known as the period of secondary incubation 
which is usually of about six weeks duration in¬ 
cluding the period of primary ulcer above given. 
The secondary period or stage lasts from a year 
to two years and is usually followed by a period 
of quiescence lasting from two to four years. The 
tertiary period which follows is of indefinite 
duration. The tertiary period is characterized by 
organic disease of the bones, vessels, viscera and 
skin and is regarded by most authors as noninfec- 
tious. 

The diagnosis of syphilis at present depends 
entirely on the history of exposure, the clinical 
picture as presented above and a tolerance for 
certain lines of treatment. The initial ulcer of 
syphilis is non-phagedenic and is indurated in 
contradistinction from the chancroid commonly 
spoken of as soft chancre which is purely a local 
disease of minor importance. In the late stages 
of syphilis diagnosis depends much on the his¬ 
tory, enlarged glands and scars. 

Syphilis is unquestionably communicable in 
the first and second stages, possibly so in the 
third though most writers agree that in the third 
stage the disease is noncommunicable. The con- 


136 


SYPHILIS. 


tagion is to be found in the blood during the sec¬ 
ondary stage and in the secretion of the chancre 
(initial lesion) or of the secondary lesions. 

The sanitary precautions and regulations of 
syphilis are a very perplexing problem. It is a 
matter hard to regulate. One can do little more 
than advise. Quarantine is practically out of the 
question. Licensed prostitution on a basis of 
health certificates has been tried with but 

little success. Probably the greatest protec- 

( 

tion is to be found in education, moral as 
well as intellectual. The infected dressings and 
utensils should be disinfected by means of the 
stronger antiseptics, fire or boiling. The syphilitic 

should certainly not be permitted to marry for at 

\ 

least two or three years after contracting the dis¬ 
ease and then not unless persistent intelligent 
treatment has been pursued throughout the entire 
course of disease; certainly not unless there has 
been no syphilitic outbreak for from six months 
to a year. 




Gonorrhoea. 


GONORRHOEA OR SPECIFIC URETHRI¬ 
TIS is an acute infectious disease characterized 
by an inflammation of tlie urethra. The specific 

•» V 

cause of gonorrhoea is the micrococcus gonor¬ 
rhoea, the usual source of infection being ven¬ 
ereal. In the female subject in addition to the 
urethra the labia, vagina and frequently the mu¬ 
cous lining of the uterus and Fallopian tubes are 
also involved. 

t 

Incubation lasts from two to ten days, the 
early symptoms being pain on urination and a 
burning sensation. There is soon a discharge of 
yellowish green pus. The diagnosis is made from 
the above symptoms, a history of exposure and 
by means of the microscope. 



Figure XXXVI. 

Gonococci. 


Gonorrhoea is contagious so long as the micro¬ 
organisms are present. This may or may not be 
throughout the entire course of the disease but 
always last throughout the acute period which is 
of indefinite duration. In all cases where the 
microscope is not brought into use gonorrhoea 
should be regarded as transmissible until all dis¬ 
charge has ceased. 


138 



GONORRHOE2A. 


What has been said of quarantine and restric¬ 
tive measures in the consideration of syphilis 
applies with equal force to gonorrhoea. Soiled 
dressings should be burned or disinfected with 
moist heat or powerful antiseptic chemicals. Ac¬ 
cording to Sternberg moist heat at 140 degrees 
kills the germs in ten minutes. The patient 
should be cautioned to observe strict cleanliness 
with reference to his hands and to guard carefully 
his eyes, not raising to them either soiled hands 
or towels since gonorrhoeal infection of the eyes 
nearly always results in the loss' of one or both. 




I • 



Tuberculosis. 


TUBERCULOSIS is an infectious disease the 
course of which is sometimes acute, sometimes 
chronic. The affection is characterized by little 
nodular bodies called tubercles. These bodies 
undergo either caseation, or sclerosis or become 
calcified. 

The specific’cause of tuberculosis is a bacillus 
known as the bacillus tuberculosis. This organism 
is identified by peculiar methods of staining. The 
micro-organism is found in all tubercular tissue 
and especially in developing tubercles. 

Most cases of tuberculosis are doubtless due to 
a direct infection from sputum. Spitting on 
streets and floors, hanging up cloths to dry after 


/ 







^11) V -V wtt 


' • U- - 

Figure 


XXXVII. 


Bacillus Tuberculosis. 


they have been used to catch sputum, closely 
confined atmosphere in infected rooms, poor light 
and poor qualities of food are all potent factors in 
the spread of tuberculosis. Domestic animals are 
affected but a question has been raised recently 
as to the power to transmit tuberculosis from 
domestic animals to man and is at present un¬ 
settled. Extremely rare cases appear to be con¬ 
genital. The influence of heredity is an open 
question, a matter the truth of which is hard to 
determine. Most cases attributed to heredity are 


140 



TUBERCULOSIS. 


probably the result of lowered resistance favoring 
ready response to infection. The expired air of a 
tuberculous' patient is usually not infectious but 
the sputum is highly so and in a dried state is 
easily carried about as dust particles. Infection 
with ingesta is possible but as a rule infection of 
the alimentary tract is subsequent to an infection 
of the air passages. Tuberculosis or the tendency 
to tuberculosis seems to be more frequently trans¬ 
mitted through the mother than the father. 
Races as such are not immune but certain peo¬ 
ples seem to be more commonly affected than 
others. For instance, the Irish, Negroes and In¬ 
dians are very susceptible whilst among t he 
Jews tuberculosis is not so common. Recently 
this alleged immunity of the Jews has been called 
in question however and it is possible the condi- 



Flgiire XXXVIII. 

Sputum cup and paper filler. 


tions may be the result of differences other than 
racial. All ages are affected but most cases occur 
from eighteen to thirty-five years of age while 
from five to ten years of age there seems to be a 
period of relative immunity. 

Incubation, owing to the very insidious nature 

141 


0 






























































TUBERCULOSIS. 


of the infection is hard to determine and differs 
greatly no doubt in different cases. 

The diagnosis is usually plainly marked in the 
clinical picture though at times may be difficult 
to make out. The microscope affords a valuable 
aid to the diagnosis. Diagnosis is sometimes 
most easily effected by means of exclusion. The 
rapid loss of weight and a continued slight eleva¬ 
tion of temperature are frequently considered 
diagnostic although it is hardly safe to rely on 
these two symptoms alone. Local symptoms de¬ 
pend on the parts involved. 

The sanitary regulations to be observed should 
include disinfection of all discharges by fire, bed 
linen and other wash goods by moist heat (either 
steam under pressure or boiling for thirty to 
sixty minutes), and plenty of fresh air and sun 
light. The spitting habit should be prohibited on 
streets and in public buildings. I doubt the 
advisability of isolation in these cases. Tuber¬ 
cular farms are yet in the experimental stage. 
What they may do towards checking the disease 
is yet to be learned. Kissing and matrimony 
should not be thought of by the tubercular. 
Utensils such as spoons, glasses, knives, forks 
and dishes should of course be thoroughly boiled 
before using again. 




Malaria. 


MALARIA is an infectious disease manifesting 
itself in a variety of types which are classed as 
separate diseases by some writers. All, however, 
are caused by the micro-organism known as the 
plasmodium of malaria. The plasmodium of 
malaria differs in several respects from the bac¬ 
teria the organism belonging to the class pro¬ 
tozoa, being one celled structures having the 
characteristics of animals. The differentiation is 
not essential in this connection. The different 
affections classified under the general head 
malaria are characterized by one common symp¬ 
tom, periodicity and periodicity in a section in 
which malaria is found always suggests this affec¬ 
tion. The various names of the different types of 
malaria arise frequently from some peculiarity of 
symptom or course found in the one form of 
malarial manifestation. The plasmodium of 
malaria is found in the blood. Of this organism 
are found several different varieties which occa¬ 
sion differing cycles of disease process. For a 
differentiation and classification of these varieties 
the reader is referred to any standard work on the 
pathological parasites. 

As conditions favorable to the development of 
malarial affections may be mentioned a warm, 
temperate or tropical climate and a low marshy 
ground. A plowing or stirring up of the ground 
seems for a time to aggravate matters, but con¬ 
tinued cultivation and the planting of trees are 
advantageous. A drainage of swamps also seems 
to afford considerable relief. Lands once under 
cultivation and permitted to relapse to the wild 
state are particularly likely to favor the develop¬ 
ment of malarial agencies. The summer and fall 


J43 



MALARIA. 


are the seasons at which malarial processes are 
most likely to appear. 

Impure drinking water has been severely 
arraigned by some and acquitted by others. It 
seems reasonable to suppose that bad water or at 
least stagnant water affords an excellent breeding 
place for the contagion. It cannot be denied at 
least that stagnant water affords ideal breeding 
places for the mosquito which has been tried and 
found guilty of transmitting malaria, inoculating 
its victims as it gets its food. 

Age is not an important factor of susceptibil¬ 
ity or immunity. 

Widely differing views have been expressed on 
the question of incubation. It is still an open 
question on which nothing definite can be said as 
to the duration. 

Diagnosis depends on the microscope and the 
clinical picture of a given type. Differentiation 
must be made from typhoid fever aside from 
which possibly there need be little or no confu¬ 
sion in diagnosis. In masked forms of malaria, 
however, grave errors of diagnosis may be com¬ 
mitted. Susceptibility to a large degree depends 
on acclimation of the individual and the resistive 
powers he may be able to command. 

To avoid malarial infection when in malarial 
districts one should sleep on the second or third 
floor and should take a daily dose of quinine. 
Since the mosquito has been proven to be a factor 
in malarial infection screens should guard 
sleeping apartments. In addition to the above 
sanitary precautions may be mentioned the 
liberal use of coal oil as a destructive agent to 
the mosquito in its early stages of development. 
The oil is to be used freely on the stagnant water 
of suspected breeding places. 


144 


'Dengue or Breakbone FeVer. 


DENGUE OR BREAKBONE FEVER, an 
acute infectious disease is characterized by two 
paroxysms of fever and severe pain. The affec¬ 
tion is doubtless caused by. a specific germ but 
this fact has not been proven. Dengue is found 
in warm and hot climates and seems to be favored 
by a warm, moist atmosphere. The susceptibility 
does not seem to depend in any special degree on 
age, race, sex of social position. 

Dengue prevails in epidemic form, but its com¬ 
municability has been questioned. Immunity and 

.1 

recurrent attacks are also unsettled ^questions, 
good authority being arrayed on both sides. 
Incubation last froni two to five days. 

Chief reliance must be made on the clinical 
picture in making a diagnosis holding in mind the 
characteristic symptoms. These are rigors, two 
paroxysms of fever, a rash, occasionally hemor¬ 
rhages from mucous membranes, great pain, pro¬ 
nounced depression and a slow convalescence. If 
there be any confusiqn it is likely to^be made with 
yellow fever but this need only occur in isolated 
cases if at all. Malaria and typhoid fever might 
also be considerations in making a diagnosis but 
a careful analysis of the symptoms and recourse 
to the microscope should clear away all doubt 
with reference to these affections. Other than 
general hygenic principles there are no sanitary 
precautions to be recommended. Quinine, how¬ 
ever, is said to be prophylactic in some degree. 




145 



, Relapsing ,FeOer. 


RELAPSING FEVER is an acute infectious 
disease characterized as suggested by the name, 
by intermission and relapses. The specific cause 
of relapsing fever like that of most other com¬ 
municable diseases is a micro-organism, in this 
instance the spirochaeta Obermeieri. This or¬ 
ganism is found in the blood but only during the 
fever. The habitat and life history of the organ¬ 
ism is not yet kno^vn. Neither do we know just 
how it is given off from the system, but that it is 
so given off we know from the fact the disease is 
communicated by personal contact. From one to 
fourteenMays with an average of seven days are 
the time limits usually placed on the period of 
incubation. Diagnosis depends on the character¬ 
istic symptoms to be verified by the microscope. 

Susceptibility to relapsing fever seems to be 
’greatest between the ages of fifteen and twenty- 
five though no age is exempt. Sex and season do 
not seem to be of any great importance in this 
relation. 

The sanitary precautions resolve themselves 
into isolation, plenty of good, nutritious food and 

proper hygienic observations including good ven¬ 
tilation. 



Dysentery. 

X. > ^ . i r, _ 

DYSENTERY is a term including a num¬ 
ber of differing types of disease process; all 
showing in some degree inflammation of the 
colon, all characterized by frequent stools, 
pain, straining and prostration, and all proba¬ 
bly due to parasitic origin, the amoebic form 
certainly so. This latter type, amoebic dysentery, 
is due to the amoeba coli. Irritating ingesta, 
climate, sudden change of temperature, constipa¬ 
tion and bad'Water should all be included in a 
list of contributory causes. No age seems to be 
exempt. Incubation though probably of short 
duration is an unsettled question. The clinical 



Figure XXXIX. 

. f 

Amoeba Coli. 


picture aided by the microscope in the amoebic 
form furnishes the means of diagnosis. 

The sanitary precautions to be observedjare the 
same as those given for guidance in typhoid fever 
cases. The stools and all soiled bedding or cloth¬ 
ing should be thoroughly disinfected, special care 
being taken to avoid contaminating the water 
supply which should it is needless to say be of 
first quality. General hygienic measures should 
prevail. 

Attacks of dysentery render no immunity. Two 
complications are to be expected in a certain per¬ 
centage' of the cases, namely, > abscesses .of the 
liver and of lung tissue. . 7 


147 



Yellov? FeVer, 


iYELLOW FEVER is an acute infectious dis¬ 
ease characterized by fever, suppression of,urine 
and' passive hemorrhage from the mucous sur¬ 
faces. There is likewise great depression. Strictly 
speaking tHe disease is infectious rather than con¬ 
tagious disease occupying in this respect a ^like 
position with typhoid. Immediate contact is 

neither sufficient nor always essential to occasion 
* - •* » 

yellow fever. The essential factor is the intro¬ 
duction of the conta'gion or infectious element 
into the system. This agent is probably though 
not certainly known to be a micro-organism. The 
contagion once introduced into the system seems 
to multiply with great rapidity. Dr. Parks says 
yellow fever is a fecal disease. All authorities 
seem to agree it is a disease of filth. 

The mosquito is undoubtedly an agent of dis¬ 
semination of great powder and activity so great 
that some observers are inclined to make it the 
sole agent of dissemination, even to' excluding 
fomites as a factor. The latter position, to my 
mind, seems rather extreme, though I have had 
no opportunity fon personal observation. The 
affection is essentially a disease of hot'climates 
and is usually confined to the larger cities along 
the'sea coast. - During epidemics, however, it may 
invade the inland to' some considerable- extent 
along lines of travel. This fact would seem to 
argue some little against the mosquito as a sole 
agent of dissemination. 

Acclimatedipersons seem to be rather less sus¬ 
ceptible than travelers and Negroes seem less 


14S 



YELLOW FEVEH. 


susceptible than either acclimated whites or 
travelers. This feature of the Negro is manifested 
in a mildness of attack however rather than 
absolute immunity. 

.The period of incubation is estimated at from 
pne to five days, sometimes even longer.,. 

The diagnosis of yellow p fever is largely de¬ 
pendent on ^ the clinical picture and is sometimes 
very difficult in isolated cases.. During epidemics 
of ..course the diagnosis is greatly simplified. , 
„The disease is transmissible throughout its 
entire course and following until proper disinfec¬ 
tion, has ■ been executed. .. Immunity follows*, an 
attack. V. , r** 

■ In yellow fever the patient should^ be isolated 
and a strict^ quarantine observed. Thorough dis¬ 
infection should be applied to all clothing, bed¬ 
ding, rooms and excreta and efforts should be 
directed toward a destruction of the mosquito by 
means of petroleum in the swamps and breeding 
places of the insect as before described (see Ma¬ 
laria). ' 






i.v; - ■ i i'ci’r'. 


4 

V. 

vni> rifjrit 


arii fro r»;F-- 

rr '.‘.id 

i'l-uiT! vi:) / 



fjdfT ,rlO ) '10 o?q -it 'jqOD:-' 

aoki^-) fjfir iri o.-fo i.-fqBT A V) ocnuo 

bo,;, vror' ifolBvnu:. r^dJo rii t.Ld 

jr.vorlQOO'idt 




Cholera. 


CHOLERA is a very acute infectious disease 
characterized by great depression, vomiting, pain, 
diarrhoeal discharges, emaciation, etc. 

A micro-organism known as the spirillum of 
cholera is the specific causative agent of this 
affection. As contributory factors in the causa¬ 
tion of cholera may be again mentioned the usual 
category of filth, warmth, moisture, debauchery 
or any thing that tends to a lower vitality. Con¬ 
trary to the opinion of the general public cholera 
is not transmitted through the air directly, but is 
introduced into the system through the agency of 
food or water. : > i 



i'll 


\ ))) 



Figure XL. 

Spirillum of cholera. 






The diagnosis depends on the clinical picture 
and on the microscopic findings. It more nearly 
resembles cholera morbus or cholerine than any 
other affection but in cholera the depression is 
very much more profound. In cases where the 
diagnosis is at all in doubt however the micro¬ 
scope is conclusive evidence pro or con. The 
course of cholera is a rapid one in the fatal cases 
but in other cases convalescence is prolonged 
throughout weeks. 


150 



CHOLERA. 


From what has been said regarding the etiology 
of cholera it will be readily seen that cleanliness 
is a prime factor in the prevention of the disease. 
Cholera centers, such £s are found in certain parts 
of the world as a result of massing great assem¬ 
blages of people of filthy habits, should be stamped 
out either by the prevention of such assembling 
or by the enforcement of most rigid sanitary 
regulations overcoming the filth. The germs of 
cholera do not withstand the action of sunlight 
and drying to any great extent, hence in natural 
forces if but given opportunity we have powerful 
allies. As direct sanitary measures should be 
employed (using the most exacting methods 
hereinbefore described) disinfection of the hands, 
person and clothing of physician and attendants, 
all dejecta, clothing, bedding, rooms and in short 
all infected material observing strict quarantine 
precautions until such measures have been ob¬ 
served. As a disinfectant a carbolic acid solution 
of not less than one per cent strength is very 
efficient. 


I 



s 


The Plague. 


THE PLAGUE, an acute infectious disease 
which has of late occasioned much interest in 
this country owing to its recent invasiorf of 
American soil is characterized by fever, inflam¬ 
mation of the lymphatic glands, particularly 
those of the groin, and occasionally ecchymoses. 

' 4 


Bubonic plague properly belongs in the eastern 

«*ik 

hemisphere where it prevails in widespread epi¬ 
demics and is extremely fatal. The disease is due 
■ ♦ 

to a specific micro-organism of the class bacillus. 
Poor food, filth and mental or physical depres¬ 
sion again act as predisposing or contributary 
causes. Rats are said to be important agents in 
the dissemination of the disease. 


It is strange but none the less true that persons 

4 -4 

of fifty years and over are but seldom attacked. 

The contagium of the plague usually enters 
the system through the respiratory organs, the 
alimentary tract or skin abrasions. It is very 
potent. After infection, follows a period of incu¬ 
bation lasting from two to eight days. The usual 
period of incubation however is not longer than 
five days. 

The diagnosis depends on the clinical picture as 
outlined in the characteristic symptoms men¬ 
tioned above, to be verified by the microscope. 
The characteristic symptoms are as a rule so 
plain as to occasion but little or no doubt. 

The sanitary requirements are similar to those 
given for cholera. All conditions which might be 
classed as contributory should be removed. 
Quarantine restrictions should be rigidly enforced 
throughout the entire period of possible trans- 


152 



THE PLAGUE. 


mission. There should be a thorough disinfection 
of all exposed robms, articles of furniture, cloth¬ 
ing, dejecta, persons, corpses, etc. The final dis¬ 
position of a body dead from the plague is a most 
important consideration since they are capable of 
transmitting the disease for a time. Cremation is 
probably the best method of disposal of these 
bodies, though a thorough embalmment and dis¬ 
infection as outlined in Chapter VIII. may be em¬ 
ployed where for any reason cremation is imprac¬ 
ticable. I 

rcThe -affection seems to be communicable 
throughout the entire course of the disease and 
as * indicated above until proper , distinfection 
methods have been employed. 



f 



Blood Poison. 


BLOOD POISON is a very indefinite term 
which includes a number of disease processes all 
(save perhaps one form) infectious, all acute, all 
the direct or indirect result of micro-organisms 
and all of more or less gravity. Three forms of 
the disease process however constitute the cases 
usually classed as “blood poison.” These three 
forms are occasioned in the following manners: 
There may be an introduction into the system of 
a toxine (poison) the result of bacterial activity 
which probably acts as a disease producing agent 
in a purely chemical manner. This form is known 
as sapraemia. There may be introduced into the 
system micro-organisms which multiply and gen¬ 
erate toxines which are not local irritants and 
which do not induce secondary abscesses but 
which occasion disease processes through their 
toxic effect on the nervous system. This form is 
known as septicaemia. Again there may be intro¬ 
duced into the system micro-organisms which 
multiply, which are local irritants or which gen¬ 
erate toxines which act as such and which occa¬ 
sion secondary abscesses at widely distributed 
points. This form is known as pyaemia. These 
three forms of blood poison may be united in 
various combinations. Indeed a case of pure 
sapraemia, pure septicaemia or pure pyaemia is 
the exception rather than the rule. 

We have a group of micro-organisms known as 
the saprophytic bacteria which act as agents in 
reducing dead organic matter to more simple 
forms and to this class belong the organisms 
which occasion putrefaction of dead animal tis- 


154 



BLOOD POISON. 


sue. In this process of putrefaction are formed 
certain substances, chemical in character, some 
of which are highly poisonous. To these bodies 
have been given the name ptomaines. The most 
recent observations however make it a question 
of some considerable doubt as to the most toxic 
of the bacterial products being properly classed 
with the ptomaines but fail to give us anything 
more definite as to their nature or proper classi¬ 
fication. But regardless as to whether they be 
ptomaines or not we know that highly toxic sub¬ 
stances of a number of varieties are generated in 
the process of putrefaction by bacteria and that 
of some of these toxic substances a very small 
quantity if introduced into the blood current is 
sufficient to occasion alarming results. Too these 
same substances are capable of occasioning 
marked toxic symptoms when absorbed from the 
gastro-intestinal tract. 

Briefly stated the symptoms of sapraemia are a 
chill, (may not be present) fever usually follow- 
ing absorption of the toxines within twenty-four 
hours, a tongue coated, at first moist and later 
dry, lessened secretions, headache, prostration, 
diarrhoea, sometimes vomiting and a muttering 
delirium. The most pronounced symptom of 
sapraemia however is prostration. 

In septicaemia or septic infection we have a 
distinctly infectious disease, there being present 
in the blood micro-organisms which multiply and 
which generate toxines which are not irritants 
and which do not occasion secondary abscesses. 
In sapraemia the toxines are absorbed from a cir¬ 
cumscribed source. In septicaemia the toxines 
are generated within the blood itself after an in¬ 
fection at some given point. In septicaemia the 
amount of virus or contagium introduced is not 


155 


BLOOD POISON. 


essentially great. Indeed the amount necessary 
to light up the disease process may be exceedingly 
small, even microscopic. This is the process 
which occurs in the so-called “blood-poison” 
following dissection wounds. There are a variety 
of different micro-organisms capable of inducing 
septicaemia differing in different animals and 
even in the same individual. Their morphology 
has not as yet been perfectly worked out and is 
not essential in this connection. 

The primary leasion in septicaemia is usually 
a suppurating wound or an abscess though some¬ 
times a small fresh wound or skin abrasion 
through which infection occurs. The period of 
incubation in septicaemia is usually .shorty say 
from two to four days. Then follows a. chill, 
fever reaching 102 to 104 F. (sometimes much 
less) sweating, an erythematus eruption, and 
prostration. The symptoms are very similar to 
those of sapraemia with these differences. There 
is more probability of sweating in septicaemia 
than in sapraemia and in septicaemia there is a 
period of incubation, the disease is slower iix 
aggression and more persistent. In cases of sep¬ 
ticaemia which follow slight and recent injuries, 
in addition to the above general symptoms are 
found locally great swellings, blebs and red 
lines running from the point of infection in the 
course of the veins and lymphatics. At the point 
of infection a vesicle is sometimes formed. 

The essential feature of pyaemia is an infection 
in which micro-organisms are found in the blood 
which either act as irritants or which generate 
toxines which act as such and thereby occasion 
inflammation of the inner coat of blood vessels 
and secondary abscesses. The infection proceeds 
from a suppurating surface and therefore pyae- 


BLOOD POISON. 


mia is^not to be expected as a complication fol¬ 
lowing an injury until after a lapse of from five 
to ten days.. In the process of suppuration the 
pus germs invade the lumen of a vessel, cause an 
inflammation of the inner wall of the vessel and 
at this point a clot is formed. Portions of this 
clot or thrombus become detached and form 
emboli, infected as a matter of course, which are 
carried in the blood current to some point, it may 
be very distant from the site of formation, at 
whjch they are lodged in new vessels forming 
new foci for infection. The areas of tissue which 
these latter vessels supply with blood are, of 
course, deprived of nutrition and furnish excel¬ 
lent fields for microbic development and abscess 
formation. These secondary abscesses may be 
widely distributed throughout the body the 
lungs however being very frequently among the 
first of the tissues to.be so involved. It is easy 
to see how new emboli may become detached and 
a repetition of the process continued indefinitely. 
In this process it is not infrequent that entire 
m.asses of pyogenic organisms become detached 
and form emboli in the blood current. 

The symptomatology of pyaemia is not spec¬ 
ially different from, that of septicaemia other 
than as dependent on the secondary abscesses 
and these differences will suggest themselves. 

The various types of “blood poison” present 
marked differences in postmortem appearances. 
An effusion of dirty colored fluids into the serous 
cavities is usually found in septicaemia. The 
lungs are congested and the liver presents a fatty 
appearance. The kidneys are also usually con¬ 
gested and present on section what is known as 
a dirty appearance. Most of the mucous mem¬ 
branes present a greater or less degree of 


BLOOD POISON. 


catarrhal inflammation. Sapraemia when pro¬ 
longed for any considerable time shows similar 
changes to those of septicaemia though usually 
these changes are not of so marked a type. In 
both forms the mucous lining of the gastro-in- 
testinal tract seems to be particularly affected. 
The postmortem appearances of pyaemia are 
much more characteristic. The inner coats of 
the veins, arteries and heart are inflamed, 
roughened and softened. Sometimes the inner 
lining of the heart presents vegetations the most 
probable situation of these being on the valves. 
Coagula are sometimes found in the heart and 
vessels and sometimes the vessel walls are found 
to be thickened and of a greenish color. Where 
coagula occlude the lumen of a vessel a wedge 
shaped area of tissue depending on this vessel 
for nutrition is found to present a grayish color. 
This area later breaks down into a purulent mass. 
Such areas are known as infarcts and are most 
frequently found in lung tissue though they are 
by no means confined to these organs. Joints 
may have become involved in inflammatory pro¬ 
cesses and show corresponding changes. Hem¬ 
orrhagic spots are found. In all forms of “blood 
poison” the postmortem appearance of the blood 
is that of a dark fluid or semi-fluid, sometimes 
presenting even the appearance and consistency 
of tar. It is riot often coagulated in the usual 
sense of the term. Rigor mortis is apt to appear 
early in these cases and passes off in a short 
time. Putrefactive changes occur early and pro¬ 
gress with marked rapidity. The above post¬ 
mortem changes are outlined only that the differ¬ 
ent forms of blood poison may be clearly under¬ 
stood. 


158 


BLOOD POISON. 


There is but one chief factor in the considera¬ 
tion of an individual’s susceptibility to “blood 
poison,” namely, physical condition. Age, race 
and sex apparently do not enter as factors. 

Given all the conditions save a physical debility 
or a disturbed gastro-intestinal function and fre¬ 
quently great exposure is followed by no unto¬ 
ward manifestations whilst often a slight ex¬ 
posure in the same individual, with a debility or 
disturbed stomach or intestine, will result in 
most alarming or even fatal symptoms. 

Pyaemia and septicaemia are regarded as in¬ 
fectious whilst sapraemia is usually not so re¬ 
garded. The relative gravity of these three 
forms is expressed in the order of their considera¬ 
tion namely, sapraemia, septicaemia and pyae¬ 
mia. Sapraemia is not usually fatal providing 
the source of intoxication be removed early. Sep¬ 
ticaemia is of grave import and pyaemia is 
usually fatal. 

The sanitary precautions other than absolute 
asepsis in all operations and antisepsis in sup¬ 
purating conditions include general sanitary and 
hygienic observances; room, clothing and bed¬ 
ding disinfection as before outlined and the 
destruction of all soiled dressings from wounds, 
etc. For the body the usual embalmment is suf¬ 
ficient. For further consideration of “blood 
poison” the reader is referred to the chapter on 
Wounds of the Knife, Needle, etc. 



Puerperal FeVer. 

»» 

f 

-• ^ - 

r- ■ 

PUERPERAL FEVER is'an acute infectious 

disease following labor and characterized by 

arrested lochia, pain, tenderness, elevation of 

temperature, rigors and such other symptoms as 

are attendant on an inflammation of the uterus, 

' * 

its appendages or the peritoneum. As stated 
above puerperal fever is an infection in many 
instances being a good example of sapraemia, 
septicaemia, or pyaemia. The ordinary pyogenic 
bacteria are the specific organisms concerned, the 
source of infection being retained .secundines, 
soiled clothing or improperly asepticised hands 
or instruments of the accoucheur or nurse. 

There is usually a period of incubation in puer¬ 
peral fever lasting about five days. The prophy¬ 
laxis is embodied in one word, cleanliness— 
absolute surgical cleanliness. When puerperal 
fever is met with the patient should be isolated 
from others in the puerperal or pregnant state 
and such rules of disinfection employed as were 
given for erysipelas. 




• Influenza or LaGrippe. 


INFLUENZA OR LA GRIPPE is an acute 
infectious disease characterized by a catarrhal 
inflammation of mucous membranes, (particularly 
those of the respiratory tract) prostration, pain 
and a tendency to complications such as pneu¬ 
monia, bronchitis, etc. 

A rod shaped bacillus is the specific cause of 
influenza. Communication may be either direct 
or indirect the contagium most probably entering 
the system through the respiratory organs. ^ 

Age, sex and race are probably not factors in 
susceptibility save as they influence powers of 
resistance, but in prognosis age is an important 
consideration the affection showing a marked 

Y. 

fatality in the aged. 

The period of incubation is short and in some 
cases is doubtless less than twenty-four hours. 

The sanitary precautions to be taken are few 
and briefly stated. Avoid public meetings during 
the prevalence of influenza. Disinfect the sputum 
of known or suspected cases. Isolate patients 
suffering from the affection and treat a body dead 
of influenza as capable of transmitting the dis¬ 
ease. 


: . lO V ' i 

ct : ai } ‘ 
- / - 
■i ^ ^ ^ i <-• 

1 


161 



Pneumonia or Lung Fever. 

t ' 


PNEUMONIA OR LUNG FEVER is an 
acute infectious disease characterized by a chill, 
fever, prostration, inflammation of lung tissue 
involving all or a part of one lung or both lungs, 
and by such other disturbances of the constitu¬ 
tion as might be expected from such inflamma¬ 
tion. 

■ i • i- 

The specific cause of pneumonia is the diplo- 
coccus pneumonia, the predisposing causes being 
exposure, lowered vitality, previous attacks and 
alcoholism. 

I ... - t 


he 



^ Diplococci of pneumonia imbedded in 

exudate of fibrin. 


All ages are susceptible to pneumonia the fatal¬ 
ity however being greatest at the two extremes 
of life. 

The pneumococcus as the organism is some¬ 
times called withstands drying to a marked degree 
and may be easily transmitted through the at¬ 
mosphere. Indeed in most cases it is probably 
so transmitted. In ordinary light and in the 
dried state the organism will remain virulent for 
weeks. 


162 



PNEUMONIA. 


Incubation is a matter of but short duration 
the exact period not having been determined. 

Isolation is of prime importance as one of the 
sanitary precautions which should include free 
ventilation, and disinfection of sputum either 
by boiling or burning the cloths used in this 
manner or where available using the wood pulp 
boxes made for this purpose (see figure 38) arid 
burning these. Following a case of pneumonia 
the rooms should be cleansed by the ordinary 
house-cleaning methods. 




. i 


r I A, 4 - ^ ^ 




■r ■'* '-^3 

. .'I'y •• i I'v 

bn:; 


b;; ( 





b::orb: 

.Isajnjfi'v 


Leprosy. 


ii 


i 


LEPROSY is a chronic infectious disease due 

e« r ■ 

to the bacillus leprae and characterized by nodules 
and areas of anaesthesia due to nerve changes, 
the above mentioned nodules occurring in the 
skin and mucous membrane. 

^There is but little leprosy in America save in 
Mexico and the Giilf States. All classes of people 
and all ages are susceptible to leprosy the trans¬ 
mission usually occurring by infection. In this 
respect leprosy should be placed in the same 
class as syphilis. According to Morrow most 
cases are propagated through sexual congress. 
Heredity is said to be a factor in the transmission 
of leprosy but to what extent has not been fully 
determined. 

In dealing with leprosy all dressings should be 
burned, the patient isolated and marriage pro¬ 
hibited. 




Lockjdii^, 


. TETANUS OR LOCKJAW is an acute, in¬ 
fectious disease the most characteristic symptom 
of which is the presence of tonic muscular 
spasms, the first muscles to become affected being 
those of the neck and jaw. 

The bacillus of tetanus is the specific cause of 
tetanus. This organism being anaerobic in its 
nature the infection usually occurs in punctured 
or penetrating wounds. 

All ages are susceptible to tetanus but most 
cases are found in children and old age. Males 



I j ‘ j 


r - ■ 

K • 


... ' ! f ^ : ; 

Figure XLII. 

■i- ^ V . 

Bacillus of- tetanus, lower, segment 
showing spore forms. 


■ Jr ■' 

are more frequently attacked than females doubt¬ 
less from the greater exposure of the former. 

The period of incubation is variously estimated 
at from one day to three i weeks. -ji 

The sanitary precautions to be'given are avoid 
penetrating wounds and all injuries where likely 
to be contaminated with garden soil or infections 
around stables since these places seem to be more 
likely to be infected with the tetanic bacilli, and 
when such injuries do occur see that they are 
disinfected at once, opened up to free access of 
air and kept so. Antitetanic serum is also used. 


165 




Hydrophobia, 


HYDROPHOBIA OR RABIES ’is an acute 
infectious disease transmitted from animals to 
man. The affection is characterized by spasms, a 
dread of water owing to difficulty of swallowing 
and increased convulsive action on attempting to 
do so, fever, mania, unconsciousness and death. 

The specific cause of hydrophobia is unknown 
but the affection follows bites of animals affected 
in from six to eight weeks. Wider varience of 
incubation has been estimated but has scarcely 
been proven. 

The sanitary measures are, muzzle all dogs and 
guard carefully from injury from cases of rabies. 
Wash and cauterize all such injuries with caustic 
potash or pure carbolic acid. 

The treatment of inoculation as introduced by 
Pasteur and which he claims lessens the mortality 
rate of hydrophobia is not as yet in general use. 

There is a sort of pseudo hydrophobia which 
sometimes develops in extremely nervous indi¬ 
viduals. Though only a manifestation of hysteria 
this may occasion some confusion in the diag¬ 
nosis of true hydrophobia.*? The following few 
points should serve to clear away all doubts in 
this relation. In pseudo hydrophobia there is no 
elevation of temperature, the disease is not pro¬ 
gressive and the patients recover though the 
attack may last longer than true hydrophobia the 
entire course of which does not. usually last 
longer than four days. 

. i < v ■ - ■'. '' j 


166 



Antha^ or ’Malignant' Pustule. 


ANTHAX OR MALIGNANT PUSTULE is 
an acute infectious disease very common among 
animals and occasionally affecting, man. The 
characteristic manifestations are rapidly spread- 
ing vesicles, oedema and elevation of temperature 
followed by subnormal temperature. Occasion¬ 
ally the vesicles are absent only the “oedema 
being present, this form of the disease being 
styled by Osier as malignant oedema and very 
fatal. Internal forms are met with involving 
the intestinal tract and the lungs. 

The bacillus anthracis is the organism respon- 


\/J 


/ lilt 

\L 'T 






// 

// ‘ 
// 


7///I 

7 /// 


I ss' 


\ 

'-L 


\ ^ 


y/ 


Figure XLiIII. 

Bacillus Anthracis. 


sible for anthrax. The affection is disseminated 
through handling infected wool, horns, and skins, 
through eating infected meat and through the 
agency of flies. 

All carcasses dead from anthrax should be 
burned or buried deeply with lime, human bodies 
being treated as those dead from the plague. 
Dressings should be disinfected by means of fire 
or boiling for not less than thirty minutes. Pas¬ 
teur has used protective inoculation with some 

success in animals. Incubation is so short it 
should probably be measured in hours. 


107 



Actinomycosis or Big Javf 


ACTINOMYCOSIS OR BIG JAW is an acute 
infectious disease caused by the ray fungus. It 
is characterized by tumors which break down 
into pus. These ^tumors^ may be situated in the 
alimentary canal, the brain, the skin or particu- 

•f “ 

larly around the mouth from which location 



Figure XLrlV 
Ray-fungus. 


comes the name big jaw. The infection occurs 
probably from substances taken into the mouth. 
The case should be handled as one of septicaemia 
or pyaemia. 




f 1 


C 


i 


168 



Glandersl 


GLANDERS is an infectious disease charac¬ 
terized by papules, ulcers and an inflammation of 
the lymphatics. The disease presents both acute 
and chronic forms and affects both the horse and 
man. 

The disease is caused by a micro-organism, the 
bacillus mallei. 


^ /: 


\ / I 

— 

Fiyrure XI.V. 

Bacillus Mallei. 


' / 


Patients suffering with glanders' should be 
isolated and all dressings burned. If a horse the 
animal should be killed and either burned or 
buried with lime. The stable should be cleaned 
thoroughly, burning such parts as can be re¬ 
moved and burned without too great loss and 
washing the remainder with a strong solution of 
chloride of lime. Plenty of whitewash should 
complete the disinfection. 




• X . 


IQiP 


) 





Trichiniasis. 


TRICHINIASIS is an acute disease the char¬ 
acteristic symptoms of which are pain, fever, 
prostration, gastro-intestinal irritation, inflamma¬ 
tion of muscular .tissue due to the presence of 
animal parasites, difficulty of motion, oedema and 
sweating. 

The specific cause of this affection is the tri¬ 
china spiralis, an animal parasite found in the 
flesh of swine. The swine are presumed to be¬ 
come infected from feeding on offal from slaugh¬ 
ter houses. 

The organism is usually taken into the system 
in an embryonic state through the alimentary 
tract. From infection until maturity usually re¬ 
quires about three days. Within ten days fully 
developed embryos are found in hundreds. These 
migrate via lymph channels to the muscles where 
they become encapsulated and development pro¬ 
ceeds no farther. In this encapsulated state the 
trichinae may retain vitality for many years. 

The diagnosis may be verified by employing a 
low power lense to search for the worms in the 
stools, muscles or the remainder of suspected 
meat. Aside from this process diagnosis must 
depend on the clinical picture. 

In most cases symptoms disappear in from 
three to eight weeks. Most fatal cases do not last 
longer than five or six weeks. 

In children the affection is not so likely to 
prove fatal as in adults. The mortality rate 
varies greatly ranging from 2 to 25 per cent. 

But one sanitary precaution suffices, namely 
complete cooking. A temperature of 140 F. is 
sufficient to destroy the parasites. Swine should 
not be fed from offal from slaughter pens. 


170 



Scabies^ or Itch 


SCABIES OR ITCH is an affection of the skin 
either acute or chronic and caused by an animal 
parasite known as the itch mite or acarus scabiei. 
The parasites are male and female and the female 
occasions most of the symptoms and lesions. The 
symptoms characteristic of itch are itching, and 
abrasions of the skin due to the scratching. 
There is a small inflammatory vesicle or papule 
at the point of penetration of the parasite into 
the cuticle. ^ 

The hands, particularly between the fingers, 
the forearm, abdomen and thighs are the most 
usual sites of the affection. 

The duration is indefinite. 

The prophylaxis consists in avoiding contact 
with persons affected and the sanitary precau¬ 
tions other than this consist in absolute cleanli¬ 
ness, change of clothing following cure and a 
complete disinfection of the same for which pur¬ 
pose sulphur answers admirably. 




Pediculosis. 


PEDICULOSIS. By this term is meant the 
presence of pediculi or lice on the human body. 
Three varieties are found on the surface of 
man’s body. The pediculus capitis inhabits the 
scalp, the pediculus pubis, the pubes and the 
pediculus vestimenti the clothing. These para¬ 
sites live on the blood of man and in securing this 
blood they occasion itching and irritation. They 
may be seen with the naked eye. They are seldom 
found away from the quarters above specified. 

One precaution suffices as in scabies — avoid 
contact with persons infected and observe abso¬ 
lute cleanliness. Boiling the clothing and a bath 
will remove all danger of transmitting the pedic¬ 
ulus vestimenti. Combs and hair brushes are fac¬ 
tors in distributing the pediculus capitis, whilst 
the pediculus pubis is transmitted usually in 
sexual congress or in sleeping in beds formerly 
occupied'by persons inhabited. 





INDEX. 


! -j'.ul !:'>T 
■ ' ■•>* ^ N j ‘.i ! ■ '!’ 


(. . 


. 1 


I- 

Acid, Carbolic.57, 66, 68, 123, 130, 151 

Acid, Sulphuric. 70 

Acid, Sulphurous. 70 

Acids . .. 29 

Acids, bacteria and. 34 

Actinomycosis.168 

Aerobic bacteria . ..... 31 

Air, draughts of. 73 

Air, infection and. 44 

Albumen, food for bacteria. 33 

Albumen, how effected by antiseptics. 34 

Albumen, in urine.104 

Albuminoids, food for bacteria. 33 

Albuminoids, how effected by antiseptics. 34 

Alcohol.66, 71 

Alkalies. 29 

f 

Alkalies, bacteria and. 34 

Amoebic dysentery.147 

Animals, domestic factors in disease. 

.85, 94, 121, 140, 168, 169, 170 

Animal parasites..171, 172 

Anthrax.84, 85, 167 

Anthrax, mice and.... 85 

Anthrax, rats and... 85 

Antidiptheritic serum . ....87, 88, 123 

Antiseptic power, determined how.34-36 

Antiseptics . 32-37 

Antiseptics, application of. 36 

Antiseptics, effect on albumen.’. 34 

Antiseptics, operate how. 34 

Antiseptics, poisonous . 36 

Antiseptics, requirements of. 37 

Antitoxine.87, 88, 123 

Arthrospores. 30 

Bacilli. 31 

Bacillus anthracis. *.167 

Bacillus of cholera.150 


173 









































Bacillus of diphtheria.120 

Bacillus of influenza.161 

Bacillus leprae.164 

Bacillus mallei.169 

Bacillus tetani. v... .165 

Bacillus tuberculosis.140 

Bacillus typhosus.129 

Bacteria (see micro-organism).21-31 

Basements, diptheria and.120 

Beard, infection and. 45 

Bedding, removal of. 60 

Bichloride of mercury. ...66, 68, 111 

Big jaw.168 

Birds, agents in disease. :..94, 121 

Blood poison......52-57, 154-159 

Blood poison, forms of. .154 

Blood poison, symptoms of.. . 56 

Body, how prepare for burial.58-62 

Body, washing of. 60 


Body, ultimate disposal of. 75 

Boiling, disinfection by.41, 123 

Brakebone fever... 145 

Brownian movement. 27 

Brushes, hair.172 

Bubonic plague.152, 153 

Burial. 76 

Burial, water contamination from. 76 

Carbolic Acid.57, 66, 68, 123, 130, 151 

Cats, agents in disease. 94, 12,1 


Cause of disease. 

Cell, apical. 

Cellars, diptheria and. 

Cerebro-spinal meningitis.... 

Chancre, hard. 

Chancre, soft..... 

Chancroids.. 

Chemical force. 

Chemicals as disinfectants... 

Chickenpox. 

Chickenpox, gangrenous form 
Chloride of lime. 


...15-20 

..23, 29 

... .120 

.126, 131,. 132 

..135 

. 136 

.:.136 

. ..16 

,. 41 

.. . .. . 115-117 

.116 

66, 68, 71> 123,fl30 


Chlorophyl. 21 

Cholera Asiatic...150, 151 

Chromogenic bacteria. 31 

Clothing disinfect how.46 


174 















































Clothing infection and. 45 

Clothing removal of. 00 

Coal oil.... ,. 144 ^ 149 

Cocci. 31 

Cold storage .•. 34 

Collodium. 57 ^ 01 

Combs, agents of disease.172 

Communicable diseases. 78 

Communicable diseases, classification. 80 

Communicable diseases, stages of. 89 

Consumption. 140-142 

Contagion, elements of where found.. 44 

Contagious diseases.80, 81 

Control tubes. 35 

Corrosive sublimate. 66 , 68 , 111 

Corpse, fiuids of. .54> 55 

Corpse, kissing of. 74 

Corpse, ultimate disposal of...'. 75 

Corpse, washing.■. 60 

Cremation. 75, 76, 153 

Cremation, crime and. 77 

Croup, membranous . .124 

Culture tubes . 35 

Dead bodies fluids of...54, 55 

Dead, kissing of. 74 

Decomposition. 32 

Defect, cause of disease. 18 

Delays at funerals . .>.^.. 73 

Dengue... *.!.145 

Dental instruments agents in disease.'..135 

Diphtheria .. .87, 120-124 

Diphtheria antitoxine.87, 88 , 123 

Diphtheria, basements and.120 

Diphtheria, second attacks. .<.124 

Diplococci. 31 

Diplococci of gonorrhoea. -138 

Diplococci of pneumonia. 162 

Disease, cause of...15-20 

Disease, definition of. 16 

Disease, fermentation and.. 19 

Disease, germ theory of.......'... .18-20 

Disease, horns agents of. 167 

Disease, insects agents of....44, 128, 144, 148 

Disease, mythology of. 17 

Disease, spitting agent of..28, 140, 142 


175 
















































Disease transmission. 80 

Disease, wool agent of.167 

Diseases, communicable. 78 

Diseases, communicable classification. 80 

Diseases, communicable stages of. 89 

Diseases, contagious.80, 81 

Diseases, infectious.80, 81 

Diseases, inoculable . 80 

Disinfectants. 33 

Disinfectants, chemical. 41 

Disinfectants, proprietary. 64 

Disinfection. 38-42 

Disinfection, accomplished how. 39 

Disinfection by boiling.41, 123 

Disinfection of clothing. 46 

Disinfection by fire . .-..."..39, 167, 169 

Disinfection of hands . 49 

Disinfection by heat. 40 

Disinfection, personal.43-51 

Disinfection, room , •..62-72 

Disinfection, spray.64, 69 

Disinfection, steam.40, 41 

Dissection wounds.52-57, 156 

Dogs, agents in disease.95, 121 

Domestic animals agents in disease. 

.85, 94, 121, 140, 168, 169, 170 

Draughts of air.. 73 

Drinking vessels agents in disease.v.135 

Dust, agent in disease... .28, 69, 73, 141 

Dys entery..’ .'..147 

Electricity. 29 

Embalmer, when to call.;•. 58 

Embalmment, proper time for. 61 

Emboli.157 

Endospores.'..30 

Enteric fever.79, 85, 100, 126, 128-130, 144, 145 

Epidemics, cost of. 78 

Erysipelas.133, 134 

Excess, cause of disease.. ;... 18 

Excreta, agent in disease. 44 

Faculatative bacteria . ... 31 

False measles...■...100, 102-104 

Fear, agent in disease. 125 

Fermentation.....19, 32 

Fever, brakebone.145 


176 















































Fever, enteric.79, 85, 100, 126, 128-130, 144, 145 

B'ever, lung.162, 163 

Fever, puerperal.160 

Fever, relapsing.146 

Fever, scarlet.94-97, 100, 103, 104 

Fever, spotted.126, 131, 132 

Fever, surgical. 55 

Fever, typhoid.79, 85, 100, 126, 128-130, 144, 145 

Fever, typhus.100, 125-127 

B'ever, yellow...82, 85, 148, 149 

Filth agent in disease.95, 125, 150, 152 

F’ire, disinfection by...39, 167, 169 

Fire, St. Anthony’s.133, 134 

Fission. 29 

Flagella. 27 

Flies, agents in disease ... 128 

B'luids of dead bodies.54, 55 

Fomites.94, 121, 125 

B''ood agent in disease.44, 125, 128, 140, 152, 167 

B’'ood for bacteria. 28, 33 

B^ood preservation. 34 

B^orce chemical . 16 

Force vital . 15 

Formaldehyde.42, 71, 72, 123, 130 

B^ormaldehyde, amount required.71, 72 

Fractional sterilization . 34 

Fumigation . 69 

B’'unerals .73-77 

B^'ungi, fission. 23 

Fungi, parasitic . 21 

Garden soil, agent in disease.165 

Gas, formaldehyde.71, 72 

Gases of putrefaction. 60 

Gemmation . 29 

Germicidal power of disinfectant.34-36 

Germicides. 33 

Germs (see micro-organisms) .21-31 

Germ theory of disease.18-20 

Germ theory of disease applicable to what forms.... 20 

Germ theory of disease proof of. 20 

Glanders.169 

Gloves, rubber.49, 52 

Gonorrhoea.• • • . ....138-139 

Gowns, sanitary. 47 

Grave, close when. 74 


177 














































Grave-yards, water contaminated from. 76 

Hair-brushes, agents in disease... 172 

Hair, infection and. 45 

Hands, disinfect how... 49 

Hands, infection and... 45 

Hats, removal of. 74 

Health, definition of..'. 16 

Heat, disinfection by ..’.... . 40 

Hebrews, tuberculosis and.82, 141 

Heredity, agent-in disease.135, 137; 140, 164 

Horns, agents in disease.. ..167 

Human virus. 114 

Hydrophobia.166 

Hydrophobia, pseudo . 166 

Hyphomycetes.. 21 

Hysteria.166 

Immunity.83, 89 

Immunity, acquired.85, 88 

Immunity, apparent’. ..83, 84, 88 

Immunity, duration of. 88 

Immunity, inoculation and.85, 86 

Immunity, methods of acquiring. 85 

Immunity, natural or native. 84, 85 

Immunity, vaccination and. 88 

Indians, tuberculosis and.82, 141 

Indol. 27 

Infarcts.158 

Infection, air agent in.-.. 44 

Infection, beard agent in. 45 

Infection, clothing agent in. 45 

Infection, drink agent in. 44 

Infection, excreta agent in. 44 

Infection, food agent in.. .44, 128, 140, 167 

Infection, hair agent in. 45 

Infection, hands agent in. 45 

Infection, insects agent in . ...-. .44, 128, 144, 148 

Infection, septic.155 

Infectious diseases.•... .h . .80, 81 

Infiuenza .161 

Inoculable diseases.;. . .. 80 

Inoculation, immunity and . . .•.85, 86 

Inoculation, serum .. 87 

Insects, disease and.. ..44, 128, 144, 148 

Instruments, dental, agents in disease.135 

Intermittent sterilization..i. i.. 34 


178 















































Involution, forms of bacteria. 81 

Irish, tuberculosis and.82, 141 

Itch. 171 

Jews, tuberculosis and. 141 

Kissing, syphilis and.* ... i. .135 

Kissing the dead. 74 

Kissing, tuberculosis and. 142 

Klebs-Loeffler bacillus . 120 


La Grippe 


.161 


Lemonade... 34 

Leprosy. 164 

Lice.172 

Licensed prostitution.137 

Life, definition of. .16 

Lime, chloride.. 66, 68, 71, 123, 130 

Lock jaw. 165 

Lung fever....162, 163 

Malaria..129, 143; 145 

Malaria, plasmodium of. 143 

Malignant Oedema.. .....84, 85, 167 

Malignant pustule.;.84, 85, 167 

Marriage, syphilis and.i'.137 

Marriage, tuberculosis and :•.... . ‘142 

Mattress, rubber coverings for...'.. .130 

Measles..‘..85, 98-101, 103, 126 

Measles, false .100, 102-104 

Megacocci . . •. .. '31 

Membranous croup..124 

Meningitis, epidemic cerebro-spinal.126, 131, 132 

Mercury, bichloride.66, 68, 111 

Mice, anthrax and. 85 


Microbe. 23 

Micrococcus gonorrhoea. 138 

Micrococcus lanccolatus encapsulatus.131 

Micro-organisms .21-31 

Micro, acids and . ..29, 34 

Micro, alkalies and .•......29, 34 

Micro, anaerobic. 31 

Micro, cause of disease.18, 19, 20, 81 

Micro, effect of cold on. 34 

Micro, chemicals and . 29 

Micro, chromogenic . 31 

Micro, classification of...; ......21, 31 

Micro, defined. 18 

Micro, disposal of in body... !... 26 


179 















































Micro, electricity and . 29 

Micro, facultative. 31 

Micro, food of.28, 33 

Micro, found where. 25 

Micro, healthy body and. 26 

Micro, involution forms . 31 

Micr 9 , moisture and . 27 

Micro, motion of. 27 

Micro, multiply how . 29 

Micro, parasitic. 31 

Micro, pathogenic. 31 

Micro, potent when. 84 

Micro, proofs of relation to disease. 20 

Micro, putrefactive. 31 

Micro, requirements of . 27 

Micro, saprogenic. 31 

Micro, saprophytic.31, 154 

Micro, size of . .. 21 

Micro, sunlight and.,.29, 151 

Micro, structure of. 22 

Micro, temperature and. 28, 40 

Micro, ultimate disposal of. 26 

Micro, zymogenic. 31 

Moisture agent in disinfection. 70 

Mosquito agent in disease.144, 148 

Motion of bacteria. 27 

Moulds..21, 29 

Mumps. 105, 106 

Mustard, oil of. 86 

Mythology of disease. 17 

Negroes, scarlatina and. 82 

Negroes, tuberculosis and.141 

Negroes, whooping cough and.119 

Negroes, yellow fever and...82, 85, 148 

Obermeieri, spirochaeta of.146 

Oedema, malignant. 84 

Oil of mustard. 86 

Orifices, how treat. 61 

Over crowding, agent of disease. .125 

Ozena.^.121 

Paper, wall. 69 

Parasites, animal. 171 ^ 172 

Parasites, vegetable. 23 

Parasitic bacteria. 31 

Parotiditis, epidemic.i05, 106 


180 















































Pathogenic bacteria. 31 

Pediculosis .172 

Pediculiis capitis . 172 

Pediculus pubes .172 

Pediculus vestimenti. 172 

Permanganate of potassium. 72 

Personal disinfection.43-51 

Pertussis.118, 119 

Perversion, cause of disease,. 18 

Petroleum. ^. 144, 149 

Phenol. 27 

Pipes, agents in disease. 135 

Plague the.152, 153 

Plasmodium of malaria .. .143 

Pneumonia.^.'.....162, 163 

Potassium permanganate . 72 

Power of antiseptics...... ,34, 36 

Pox.135, 138 

Preparation for room disinfection. 72 

Preservation of foods. 34 

Proof of germ theory of disease. 20 

Proprietary disinfectants . 64 

Prostitution, licensed .137 

Pseudo hydrophobia. 166 

Ptomaines.55, 155 

Puerperal fever . 160 

Putrefaction . 32 

Putrefaction, gases of. 60 

Putrefaction, observed first where. 25 

Putrefactive bacteria .. 31 

Pyaemia.154, 168 

Rabies.166 

Racial differences.82, 85, 107, 119, 141, 148 

Rash, scarlet.94-97, 100, 103, 104 

Rats, agents in disease.85, 152 

Ray fungus . ..168 

Relapsing fever .146 

Reproduction of bacteria. 29 

Requirements of antiseptics. 37 

Requirements of bacteria. 27 

Rigor mortis.158 

Room disinfection . ..62, 72 

Room disinfection, preparation for. 72 

Rose. 134, 138 

Rotheln.160, 102-104 


181 















































Rubber coverings for mattresses.vi.130 

Rubber gloves..49, >52 

Rubella....100, 102-104 

Rubeola.85, ^8-101, 103, 104, 126 

Sanitary gowns. ►ij.......... 47 

Sanitary funeral .r..73-77 

Sapraemia. 154 

Saprogenic bacteria.31 

Saprophytic bacteria... ..31, 154 

Sarcinae. 31 

Scabies . 171 

Scarletina.. .94-97, 100, 103, 104 

Scarletina, Negro and . 82 

Scarlet fever . ......94-97, fOO, 103, 104 

Scarlet rash (see scarlet .fever.). .. . . . ? 

Scatol..f. >. i.. .i;... 27 

Schizomycetes. 21 

Sepsis. 32 

Septicaemia...154, 168 

Septic infection .155 

Serum, antidiptheritic.87, 88, 123 

Serum, inoculation .. i. 87 

Sewage, typhoid and. ....; .128 

Sheet, antiseptic absorbent. 76 

Skins, agents in disease....167 

Smallpox.86, 88, 107-110, 111, 116 

Soil, agent in disease.143,••165 

Spirilla. 31 

Spirochaeta..i.. 31 

Spirochaeta of Obermeieri... 146 

Spirolina. 31 

Spitting, agent of disease.28, 140,’-142 

Spores. 30 

Sporulatipn. 29 

Spotted fever . ..126, 131, 132 

Spray disinfection.64, 69 

Stables, agents in disease... .165 

St. Anthony’s fire............133, 134 

Staphylococci. 31 

Steam disinfection...40, 41 

Sterilization, fractional or intermittant. 34 

Strawberry tongue . .....95, 104 

Streptococci. 31 

Structure of bacteria. 22 

Suits, sanitary . 47 


182 
















































Sulphur.69, 70 

Sulphuric acid.•.. 70 

Sulphurous acid. 70 

Sunlight..29, 151 

Surgical fever. 55 

Susceptibility.81, 82 

Swamps, agents in disease.v.143 

Syphilis...135-138, 164 

Syphilis, kissing and.135 

Syphilis, marriage and. 137 

Temperature and bacteria.28, 40 

'letanus . 165 

Tetracocci. 31 

Thalophytes. 21 

Thrombi .157 

Tongue, strawberry.95, 104 

Tonsilitis.121 

Toxines.20, 87, 154 

Transmission of disease. 80 

Trees agents in disease.143 

Trichiniasis .170 

Tuberculosis .140-142 

Tuberculosis, Hebrews and.82, 141 

Tuberculosis, Indians and.82, 141 

Tuberculosis, Irish and .82, 141 

Tuberculosis, Kissing agent in.142 

Tuberculosis, marriage and.142 

Tuberculosis, Negroes and . .141 

Tuberculosis, spitting agent,in.142 

Typhoid fever.79, 85, 100, 126, 128-130, 144, 145 

Typhus fever.i.100, 125-127 

Ultimate disposal of bacteria. 26 

Ultimate disposal of corpse. 75 

Undertaker, when to call. 58 

Urethritis specific.138, 139 

Vaccination.86, 88, 107, 111, 112-114 

Vaccination, dangers of.113 

Varicella .115-117 

Varicella, gangrenous form.116 

Variola.86, 88, 107-110, 111, 116 

Varioloid .HI 

Vegetable parasites . 23 

Ventilation. 

Vibria. 

Virus, human .114 


183 















































Vital force . 15 

Wall paper. 69 

Washing corpse. 60 

Water, contaminate from grave yards. 76 

Water, agent in disease.128, 144 

Whitewash . 169 

Whooping cough.118, 119 

Whooping cough and negroes.119 

Wool, agent in disease.167 

Wounds, dissection .52-57, 156 

Yeasts.21, 29 

Yellow fever.82, 85, 148-149 

Zymogenic bacteria. 31 



184 
















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